5.5c Treatment of Psychological Disorders: Evaluating Psychotherapies

Confirmation bias

A tendency to search for information that supports our preconceptions and to ignore or distort contradictory evidence

Meta-analysis

A statistical procedure for analyzing the results of multiple studies to reach an overall conclusion

Cognitive and cognitive-behavioral therapies

Primarily anxiety, posttraumatic stress disorder, insomnia, and depression

Behavioral conditioning therapies

Behavior problems such as bed-wetting, specific phobias, compulsions, marital difficulties, and sexual dysfunctions

Psychodynamic therapy

Depression and anxiety (Driessen et al., 2010; Leichsenring & Rabung, 2008; Shedler, 2010). Some analyses suggest that psychodynamic therapy and cognitive-behavioral therapy are equally effective in reducing depression

Nondirective (person-centered) counseling

Mild to moderate depression

Therapeutic alliance

A bond of trust and mutual understanding between a therapist and client, who work together constructively to overcome the client’s problem

Clinical psychologists 

Most are psychologists with a Ph.D. (includes research training) or Psy.D. (focuses on therapy) supplemented by a supervised internship and, often, postdoctoral training; about half work in agencies and institutions, half in private practice

Psychiatrists 

Psychiatrists are physicians who specialize in the treatment of psychological disorders; not all psychiatrists have had extensive training in psychotherapy, but as M.D.s or D.O.s they can prescribe medications; thus, they tend to see those individuals with the most serious problems; many have their own private practic

Clinical or psychiatric social workers

A two-year master of social work graduate program plus postgraduate supervision prepares some social workers to offer psychotherapy, mostly to people with everyday personal and family problems; about half in the United States have earned the National Association of Social Workers’ designation of clinical social worker

Counselors

Family and couples counselors specialize in problems arising from family relations; clergy provide counseling to countless people; counselors may work with people with substance use disorders and with spouse and child abusers and victims of abuse; mental health and other counselors may be required to have a two-year master’s degree

Beneficence and nonmaleficence

Seek to benefit you (beneficence) and do you no harm (nonmaleficence)

Fidelity and responsibility

Establish a feeling of trust and a defined role as your therapist, uphold a professional standard of conduct, and be of service to the therapeutic community

Integrity

Be honest, truthful, and accurate

Justice

Be fair and promote justice for you and others, helping everyone to have access to the benefits of therapy

Respect for people’s rights and dignity

Respect the dignity and worth of you and others, recognizing the right to privacy, confidentiality, and self-determination

Does psychotherapy work? How can we know?

• Clients’ and therapists’ positive testimonials cannot prove that therapy is effective, and the placebo effect and confirmation bias makes it difficult to judge whether improvement occurred because of the treatment

• Using meta-analyses to statistically combine the results of hundreds of randomized psychotherapy outcome studies, researchers have found that individuals with disorders who do not receive treatment often improve, but those who undergo psychotherapy are more likely to improve — and to improve more quickly and with less risk of relapse

Are some psychotherapies more effective than others for specific disorders?

• No one type of psychotherapy is generally superior to all others. Therapy is most effective for individuals with clear-cut, specific problems

• Some therapies are more effective for specific disorders. Cognitive and cognitive-behavioral therapies have been effective in helping clients cope with anxiety, posttraumatic stress disorder, insomnia, and depression; behavioral conditioning therapies in treating behavior problems such as bed-wetting, specific phobias, compulsions, and sexual dysfunctions; psychodynamic therapy for clients with depression and anxiety; and nondirective (person-centered) counseling for clients with mild to moderate depression

• Abnormal states tend to return to normal on their own, and the placebo effect can create the impression that a treatment has been effective

• Evidence-based practice integrates the best available research with clinicians’ expertise and clients’ unique circumstances

What three elements are shared by all forms of psychotherapy?

• All psychotherapies offer new hope for discouraged people; a fresh perspective; and (if the therapist is effective) an empathic, trusting, and caring relationship

• The emotional bond of trust and understanding between therapist and client — the therapeutic alliance — is an important element in effective therapy

What personal factors influence the therapist-client relationship?

Therapists differ both from one another and from their clients in culture, values, and personal identity. These differences — in cultural background, religiosity, or attitudes toward LGBTQ people, for example — may create a mismatch between therapists’ and clients’ goals and priorities. By building their cultural competence, therapists can better serve diverse clients

When should a person seek therapy, and what should people look for when selecting a therapist?

• People should seek professional help if they experience feelings of hopelessness, deep and lasting depression, self-destructive behavior, disruptive fears, sudden mood shifts, suicidal thoughts, compulsive rituals, or hearing or seeing things that others don’t

• High school counseling offices are generally good starting points for counseling options, and they may offer some free services. Many people also find therapists, and may meet with a therapist, online or via a mental health app

• A person seeking therapy may want to ask about the therapist’s treatment approach, values, credentials, and fees. An important consideration is whether the therapy seeker feels comfortable and able to establish a bond with the therapist

• Recognizing the importance of a strong therapeutic alliance, the American Psychological Association accredits programs that provide training in cultural sensitivity and that recruit underrepresented cultural groups

What ethical principles guide psychotherapy?

• Psychotherapists must follow their country’s ethical principles and code of conduct

• According to the APA, therapists should aim to uphold certain principles, including to benefit others and do no harm (beneficence and nonmaleficence); to be honest, truthful, and accurate (fidelity and responsibility); to establish trust (integrity); to be fair and promote justice for their clients and others ( justice); and to respect clients’ dignity, including their rights to privacy, confidentiality, and self-determination (respect for people’s rights and dignity)

Greta recently participated in a study of people with major depressive disorder. After spending two weeks on a 100-person waitlist for therapy, she and 49 others were randomly assigned to receive therapy. The remaining 50 people received no therapy. Later, all participants were evaluated and their symptoms assessed by a team of psychologists who did not know who had or had not received treatment. In what type of study did Greta participate?

A) Meta-analysis

B) Normal distribution

C) Randomized clinical trial

D) Evidence-based practice

C) Randomized clinical trial

Having recently become a therapist, Waylan feels motivated to tell his friends about the research on the effectiveness of psychotherapy. Which of the following would be the most accurate statement Waylan could say to his friends?

A) The average client who receives therapy sees greater improvement than 80 percent of untreated individuals.

B) Psychotherapy causes improvement in 80 percent of individuals who have sought therapy.

C) Clients who receive psychotherapy are no more likely to improve than individuals who have not sought therapy.

D) The average client who receives psychotherapy is 90 percent satisfied with their experience in therapy.

A) The average client who receives therapy sees greater improvement than 80 percent of untreated individuals.

Dr. Omesh is conducting an experiment investigating the relationship between the therapist-client bond and the extent to which clients are able to overcome their difficulties. Which of the following is most likely Dr. Omesh’s independent variable?

A) Therapeutic alliance

B) Hope

C) New perspective

D) Fidelity

A) Therapeutic alliance

Knowing that you have taken AP® Psychology, a friend asks your opinion about which type of psychotherapy she should consider to help her overcome anxiety. What would be your advice?

A) Psychodynamic therapy is best for anxiety.

B) Behavioral therapy has achieved the best outcomes when treating different types of anxiety.

C) Cognitive and cognitive-behavioral therapies have demonstrated effectiveness for treating anxiety.

D) It does not matter what type of psychotherapy she chooses, because anxiety can only be treated with medication.

C) Cognitive and cognitive-behavioral therapies have demonstrated effectiveness for treating anxiety.

When choosing the most effective therapy for each of her clients, Dr. Anthony considers psychological research, her own clinical experience, and clients’ unique treatment preferences. What approach does Dr. Anthony likely use?

A) Conversion therapy

B) Evidence-based practice

C) Person-centered therapy

D) Meta-analysis

B) Evidence-based practice

Which of the following scenarios illustrates the confirmation bias in the context of therapy?

A) Dr. Seinfeld focuses on negative aspects of his client’s life, reinforcing the client’s self-doubt and insecurities.

B) Dr. Austin selectively seeks evidence and remembers information that supports her preexisting beliefs about a client’s condition.

C) Dr. King’s clients tend to overlook positive changes and improvements in their mental health, leading to a distorted perception of their progress.

D) Dr. Redd tends to disregard evidence-based treatment approaches and rely solely on his personal experiences and intuition.

B) Dr. Austin selectively seeks evidence and remembers information that supports her preexisting beliefs about a client’s condition.

Andy is in therapy for depression. He experiences positive outcomes solely due to the power of his belief in the therapy’s effectiveness. Which of the following concepts is Andy demonstrating?

A) Confirmation bias

B) Effort justification

C) Placebo effect

D) Sudden gains

C) Placebo effect

Dr. Chambers has recently received his license to provide therapy to clients. He is aware that he is obligated to benefit his clients and do no harm to them. Which ethical guidelines does this represent?

A) Fidelity and responsibility

B) Beneficence and nonmaleficence

C) Respect for people’s rights and dignity

D) Integrity and justice

B) Beneficence and nonmaleficence