5 Key excerpts on "Effectiveness of Therapy"

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  eBook - ePub

  Clinical Psychology

  An Introduction

  • Alan Carr(Author)
  • 2012(Publication Date)
  • Routledge

    (Publisher)

  10 Effectiveness of psychological therapies

  Learning objectives After studying this chapter you will be able to:

  • • define evidence-based practice in clinical psychology
  • • explain the hierarchy of evidence that informs evidence-based practice
  • • summarize the main findings from the evidence base for the effectiveness of psychotherapy
  • • outline the medical cost offset associated with psychotherapy
  • • describe the role of common and specific factors in the effectiveness of psychotherapy.

  Introduction

  One of the main ways in which clinical psychologists help clients is through psychotherapy. Psychotherapy is a contractual process in which trained professionals with expert knowledge of their discipline interact with clients to help them resolve psychological problems and address mental health difficulties. Psychotherapy may be offered to children and adults on an individual, couple, family or group basis.

  Often clinical psychologists offer psychotherapy as one element of a multimodal programme provided by a multidisciplinary team. For example, a multidisciplinary adult mental health team may routinely offer a multimodal programme of cognitive behaviour therapy combined with antidepressants for depression, as described in Chapter 6 . A multidisciplinary child and adolescent mental health team may routinely offer a multimodal programme for children with attention deficit hyper-activity disorder which includes behavioural parent training, school-based behavioural consultation, child-focused self-instructional and social training and methylphenidate, as outlined in Chapter 2

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  eBook - ePub

  Counseling and Psychotherapy

  A Christian Perspective

  • (Author)
  • 2011(Publication Date)
  • Baker Academic

    (Publisher)

  Appendix Is Psychotherapy Effective? Methods of Research

  Research methods are usually categorized as quantitative or qualitative . The quantitative approach has been more widely and traditionally used thus far. It focuses on measuring the outcomes of counseling and psychotherapy as well as the processes that occur in therapy interactions that may be related to such outcomes. Outcome research is used to evaluate the efficacy or effectiveness of therapy. The terms “efficacy” and “effectiveness” are usually used interchangeably. However, in recent years some authors have used the term “efficacy” to refer to the results of scientifically controlled outcome studies that show whether a particular therapeutic technique or intervention works better than no treatment or an “attention-placebo” condition. Such studies typically involve random assignment of patients or clients who meet the diagnostic criteria for specific psychological disorders and the use of detailed treatment manuals or manualized treatments in systematically and consistently carrying out the particular therapeutic intervention whose efficacy is being evaluated. These studies are also called randomized controlled trials (RCTs) by experimental or scientific design and are basically quantitative in nature.

  The term “effectiveness” has recently been used to refer more specifically to how successful a particular therapy or technique is in real-life, clinical situations in actual practice , and not in carefully controlled scientific experimental studies such as the RCTs often used in efficacy outcome research (see M. E. P. Seligman 1995). However, most authors and texts still use the terms “efficacy” and “effectiveness” synonymously and interchangeably, as I do in the book you are now reading. It is nevertheless important to evaluate how effective a particular therapy or technique is in both carefully controlled scientific outcome studies and in real-life clinical practice. J. Hunsley and C. M. Lee (2007) have recently reviewed thirty-five effectiveness studies for adult disorders (N = 21) and child and adolescent disorders (N = 14) and found that the improvement rates in these effectiveness studies were comparable to those reported in efficacy

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  eBook - ePub

  The Use of Psychological Testing for Treatment Planning and Outcomes Assessment

  Volume 1: General Considerations

  • Mark E. Maruish, Mark E. Maruish(Authors)
  • 2004(Publication Date)
  • Routledge

    (Publisher)

  American Psychologist, 51, 1059–1064.

  Jacobson, N.S., & Christensen, A. (1996). Studying the effectiveness of psychotherapy: How well can clinical trials do the job. American Psychologist, 51, 1031–1039.

  Jacobson, N.S., Follette, W.C., & Revenstorf, D. (1984). Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behavior Therapy, 15, 336–352.

  Jacobson, N.S., Roberts, L.J., Berns, S.B., & McGlinchey, J.B. (1999). Methods for defining and determining the clinical significance of treatment effects: Description, application, and alternatives. Journal of Consulting and Clinical Psychology, 67, 300–307.

  Jacobson, N.S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

  Kazdin, A.E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1, 427–452.

  Kazdin, A.E. (1998). Research design in clinical psychology. Boston: Allyn & Bacon. Journal of Consulting and Clinical Psychology,

  Kendall, P.C. (1999). Clinical significance. Journal of Consulting and Clinical Psychology, 67, 383–384.

  Kendall, P.C., & Grove, W.M. (1988). Normative comparisons in therapy outcome. Behavioral Assessment, 10, 147– 158.

  Kendall P.C., Marrs-Garcia, A., Nath, S.R., & Sheldrick, R.C. (1999). Normative comparisons for the evaluation of clinical significance. Journal of Consulting and Clinical Psychology, 67, 285–299.

  Kendall, P.G., & Norton-Ford, J.D. (1982). Clinical psychology: Scientific and professional dimensions. New York: Wiley.

  Kopta, S.M., Howard, K.I., Lowry, J.L., & Beutler, L.E. (1994). Patterns of symptomatic recovery in time-unlimited psychotherapy. Journal of Consulting and Clinical Psychology, 62, 1009–1016.

  Kordy, H., Hannover, W., & Richard, M. (2001). Computer-assisted feedback-driven quality management for psychotherapy: The Stuttgart-Heidelberg model. Journal of Consulting and Clinical Psychology, 69,

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  eBook - ePub

  Contemporary Theory and Practice in Counseling and Psychotherapy

  • Howard E. A. Tinsley, Suzanne H. Lease, Noelle S. Giffin Wiersma(Authors)
  • 2015(Publication Date)
  • SAGE Publications, Inc

    (Publisher)

  Patients treated by means of psychoanalysis improve to the extent of 44 per cent; patients treated eclectically improve to the extent of 64 per cent; patients treated only custodially or by general practitioners improve to the extent of 72 per cent. There thus appears to be an inverse correlation between recovery and psychotherapy; the more psychotherapy, the smaller the recovery rate. (p. 322)

  With that salvo, research on psychotherapy outcomes accelerated with a vengeance. By 1967, efficacy research had moved beyond simple questions of “does it work?” Gordon Paul (1967) concluded a conceptual article with the enduring question: “What treatment, by whom, is most effective for this individual with that specific problem, and under which circumstances?” (p. 111). One of the turning points in psychotherapy research was the application of the meta-analysis statistical procedure to psychotherapy outcome studies (Smith & Glass, 1977). That provided a way to make numerical comparisons across different treatments and different outcome measures and determine whether various moderating variables (e.g., mode of treatment, number of sessions) affected outcomes. Those statistical findings provided a good way to supply evidence for psychotherapy in the managed mental health care push of the 1980s.

  The next big turning point came with the establishment of the Division of Clinical Psychology’s (APA Division 12’s) Task Force on Promotion and Dissemination of Psychological Procedures (1995). The Task Force (which has now become the Committee on Science and Practice) was established to inform consumers, managed care and insurance companies, and psychotherapists about which treatments were the strongest at dealing with which diagnostic disorders. Although the level of sophistication was still far short of Paul’s specific question, the movement was clearly in a responsible, self-policing direction. The result of that task force was the publication of a controversial compendium of treatments that had research evidence to meet different criteria for levels of empirical support (Chambless & Hollon, 1998; Chambless et al., 1996). For example, to be named an empirically supported treatment, a treatment had to be better than a control group or at least as good as a different empirically supported treatment in two independent manual-driven randomized clinical trials (RCTs). Over the years, huge numbers of treatments have been added to the rolls of the empirically supported treatments. The roll is so large that one must search specifically by topic to find treatments that are empirically supported (e.g., Association for Behavioral and Cognitive Therapies, n.d.; Australian Psychological Association, 2010; Society of Clinical Child and Adolescent Psychology, n.d.). In addition, Rozensky (2011) has argued that one implication of the passage and rolling out of the Patient Protection and Affordable Care Act (ACA, Public Law No. 111-148, March 23, 2010) is that psychotherapists are virtually going to be required to use evidence-based practices for accountability to clients and other health care professionals.

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  eBook - ePub

  Developmental Science and Psychoanalysis

  Integration and Innovation

  • Peter Fonagy, Linda Mayes, Mary Target, Peter Fonagy, Linda Mayes, Mary Target(Authors)
  • 2018(Publication Date)
  • Routledge

    (Publisher)

  There are many additional areas of worthwhile generalizability research that have not been a focus of the discussion in this chapter (e.g., generalizability of effects across cultures). It is our hope that the brief overview provided in this chapter has proved convincing, not in its specific findings, but in the overall message that research to understand the Effectiveness of Therapy in practice is a worthy goal to pursue in our next 50 years of child therapy research.

  Note

  Preparation of this manuscript was facilitated by support from the Klingenstein Third Generation Foundation, the William T. Grant Foundation, and Robert Wood Johnson Foundation, and the National Institute of Mental Health (MH064503–01A1 and MH066371–01).

  Passage contains an image

  Commentary

  Mary Target

  Robin Weersing, in an elegant and deceptively straightforward presentation of the currently most challenging issue in psychotherapy research, offers a worrying portrayal of psychological therapy services. Can therapies, shown to be efficacious in research studies, remain effective in the real world? She shows that, notwithstanding the strong evidence base of cognitive behaviour therapy (CBT) in comparison with those of other approaches, when offered in the context of a community mental health service, CBT does not show comparable effectiveness. As one of the most original and open-minded researchers currently at work, attempting to address the so-called efficacy versus effectiveness issue (the difference between research treatment outcomes and those seen in routine clinical practice), any data presented by Weersing will command attention. These data are at once intriguing and challenging. In my commentary on her views I discuss the general problems of research on psychotherapy for depression in young people and then consider ways in which psychoanalytic clinical work might benefit from Weersing’s analysis, as well as perhaps casting some further light on the findings she reports.

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