VS

Psych 401 Psychotherapy Research by Mark Aveline


INTRODUCTION 

  • Minimize bias, but clinicians have a small pool of experience 

  • Range of patients is very limited in all ways (variety + severity of problem, stage + life situation, etc)

  • Judgment is likely to be based on partial evidence and heavily influenced by recent selective experience 

  • All psychotherapy is an experiment. INfluenced by feedback and judged against the markers of progress

  • Markers of progress are: 

    • Enhanced alliance, deepened empathy, better understanding, problem resolution, satisfaction

  • Studies breed more questions than answers - what is studied may not be representative of everyday stuff

  • Research may focus on 

    • Qualitative questions

    • Quantitative questions

  • History of the field → summarize what we know about the outcomes and the process → how to implement evidence into clinical practice → anticipate future outcomes


METHODOLOGY OF PSYCHOTHERAPY RESEARCH

  • The method chosen depends on where one is in the cycle of developing or refining a therapy

  • Large effect sizes → something worthwhile in the innovation → small-scale single group designs → Effectiveness has to established through field trials; these establish generalizability →  dismantling studies tease out what are the effective ingredients in the practice being studied


Efficacy vs Effectiveness 

  • Efficacy - determined by (randomized) clinical trials in which as many variables as possible are controlled in order to demonstrate unambiguously the relationship between treatment and outcome, emphasize the internal validity, The price of high internal validity is usually poor external validity; the nature of the intervention is clear and consistent but unrepresentative of everyday practice

    • NIMH Collaborative Depression Study

  • Effectiveness - focus on clinical situations and the implementation of a treatment in clinical settings. Such studies emphasize the external validity of the experimental design. Weakness: difficult to know what was done, when, and how.

  • Menninger Psychotherapy Research Project 

  • Heidelberg Psychosomatic Clinic Study

  • Berlin Multicenter Study on Psychoanalytic Oriented Treatments


Study Design Concepts 

  • Randomized Controlled Trials 

  • Adaptation of the experimental method

  • All prior conditions except one (the independent variable) are held constant (controlled), then any differences in the outcome (the dependent variable) must have been caused by the one condition that varied

  • Quasi Experimental Designs 

  • Correlational - Process Outcome Studies 

  • Two (or more) variables are observed, and the degree to which they covary is assessed

  • Case Study 

  • A standard tool in therapy, but subject to bias and distortion 

  • Can be confirmatory and exploratory

  • Quantitative vs. Qualitative 

  • Quality: Results reported in words vs, bigger in sample size and composition 

  • Grounded Theory: bottom up observation 

  • Scientific vs Hermeneutic 

  • Scientific theory: research is cumulative, just understanding and facts

  • Hermeneutic: goal is deepening

  • Parker, Addison, Rhodes Process: observing + interpreting + reviewing + revising


CAUTIONARY POINTS 

  1. Reductionism: trade-off b/w the idea and do-able study is simplification, larger picture is lost when there is microfocus 

  2. Nonrepresentativeness: In order to control the variables, there is too much simplification, thus major narrowing of who is being studied and thus limited generalizability 

  3. Contexts: much of the variance of a study lies within the particularity of each set 

  4. Mistaking what is studied for what is important: Confounding variables may not be discovered 

  5. False positive: risk of false positives

  6. Emphasis on mental disorders: creates a categorical view, misses the “problems in living” 

  7. Comorbidity: many studies exclude comorbidities, like Axis 2 disorders, not representative of the real world

  8. Therapeutic change is not linear: cause and effect are linked in a pas de deux, it’s not linear!

  9. Manualization: internal validity > external validity. Increases reliability, replicability but decreases reflexivity. Highly prescriptive manual → limited therapist responsiveness

  10. Randomization:many conflict with the subject’s preferences 

  11. Meansures: symptoms are easier to measure than problems, good marker of distress 

  12. Statistical problems: trials must have sufficient power 

  13. Allegiance effects: researches often have loyalties, may cause systemic bias, it must be declared 

  14. Group results do not predict individual reaction 

  15. Therapy is not the only change factor in patients’ lives: unpredictable negative or positive events 


ETHICAL CONSIDERATIONS

  • Research has to be ethical → approval from Ethical Committee

  • Randomized subjects → must be equipoise

  • Possibility of doing harm has to be minimized but keep in mind it can never be entirely risk-free

  • Regulatory bodies are being a lot more careful before, ensuring there is consent for everything 

    • British Association for Counselling and Psychotherapy 


A BRIEF HISTORY OF THE FIELD  

  • Orlinsky and Russell → four phases, marked by the publication of distinct sets of synthetic reviews of the field and distinct types of major research projects.

  • Phase 1 

    • Establish a role for scientific research (therapeutic outcomes, recording therapy sessions)

  • Phase 2

    • Searching for scientific rigor, methods for measuring the events of recorded therapy sessions

  • Phase 3

    • Expansion + differentiation + organisation, growth of organisation to do psych research 

  • Phase 4

    • consolidation + dissatisfaction + reformulation, fundamental doubts about the research and how to fix it