Download Myers Module Fifty Three

Evaluating Therapies
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Client testimonials do not persuade skeptics:
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People often enter therapy in a crisis.
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Clients may need to believe therapy was worth the effort.
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Clients generally speak kindly of their therapists (anything
not to admit the treatment was a failure). (Zilbergeld, 1983).
Consider: 500 Massachusetts boys age 5 to 13 years, bound
for delinquency. Half were assigned to treatment.
30 years later, McCord (1979) assessed them from
questionnaires, public records, mental hospitals, etc.
Glowing reports from the treated! But...70% in the control
group had no juvenile record. For second crimes, alcohol,
death rate, job satisfication, untreated exhibited slightly
fewer problems.
Regression Toward The Mean
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the tendency for extreme or unusual scores to fall back
(regress) toward their average.
An example: coaches often yell at their players after an
unusually bad first half. They may then feel rewarded for
having done so when the team's performance improves
(returns to normal) during the second half.
Fig. 53.1 (m694 c 16.3 669) will be on the next exam.
Treatment vs. no treatment. These two normal distribution
curves based on data from 475 studies show the
improvement of untreated people and psychotherapy clients.
The outcome for the average therapy client surpassed that
for 80% of the untreated people. (Adapted from Smith et al.
1980)
Contrast this to Eysenck's 1952 research.
Meta-Analysis
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A statistical procedure that combines the conclusions of a
large number of different studies, by connecting them with
tight protocols such as forced-choice answers. (Eysenck
invented them).
Is psychotherapy also cost-effective? When people seek
psychological treatment, their search for other medical
treatment drops--by 16% in one digest of 91 studies (Chiles
et al., 1999).
Psychotherapy on average is somewhat effective--but that
refers to no one therapy in particular.
In many surveys, clients seem equally satisfied whether
treated by a psychiatrist, psychologist, or social worker,
whether in groups or as an individual, whether the therapist
had extensive or limited training and experience. (Seligman,
1995).
Comorbidity vs. Specific
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Some therapies succeed for particular problems, though
there is often an overlap--comorbidity--of disorders.
Behavioural conditioning for bed-wetting, phobias,
compulsions, marital problems, and sexual disorders. (Baker
et al., 2008)
Psychodynamic therapy for depression & anxiety. (Driesen
et al., 2010).
Cognitive-behavioural therapy (CBT) for anxiety, posttraumatic stress disorder, & depression. (Tolin, 2010).
Fig 53. 2 will be on the next exam. Evidence-based clinical
decision-making. The ideal clinical decision making is a 3legged stool, upheld by research evidence, clinical expertise
& knowledge of the patient. (Baker et al., 2008)
The standard in Britain. (DeAngelis, 2008).
Alternative Therapies?
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EMDR (eye movement desensitization and reprocessing).
Worked for 84 to 100% of single-trauma victims participating
in 4 studies. (Shapiro, 2002).
Many skeptics suspect EMDR is the combination of
exposure therapy--repeatedly associating with traumatic
memories a safe and reassuring context that provides some
emotional distance from the experience--and a robust
placebo effect. (Lilienfeld & Arkowitz, 2007).
SAD (Seasonal Affective Disorder) One study exposed
patients with SAD to 90 minutes (experimental) or 'negative
ion generation' (control). After 4 weeks, 61% exposed
greatly improved, 32% in the placebo. (Eastman, 1998).
Morning light dims SAD symptoms. (Wirz-Justice 2009). As
effective as anti-depressant drugs or CBT. (Rohan et al.,
2007).
Commonalities
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Hope for demoralized people. (Prioleau et al., 1983)
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A new perspective. (Christensen & Jacobson, 1994).
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An empathic, trusting, caring relationship. (Godried, 1998)
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All this creates a therapeutic alliance. (Klein et al., 2003).
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Problems occur when gender and culture are ignored; AsianAmerican clients matched with counsellors who shared their
cultural values perceived more counsellor empathy and felt a
stronger alliance with their counsellor. (Kim et al., 2005).
Table 53. 1 (m 701 c 16.3 675) will be on the next exam.
Resilience the personal strength that helps most people
cope with stress and recover from adversity and even
trauma. (Mineka & Zinbarg, 1996).