Evaluating Therapies Client testimonials do not persuade skeptics:

People often enter therapy in a crisis.

Clients may need to believe therapy was worth the effort.

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 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 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 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, post-traumatic 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 3-legged stool, upheld by research evidence, clinical expertise & knowledge of the patient. (Baker et al., 2008)

The standard in Britain. (DeAngelis, 2008).

Alternative Therapies? 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 Hope for demoralized people. (Prioleau et al., 1983)

A new perspective. (Christensen & Jacobson, 1994).

An empathic, trusting, caring relationship. (Godried, 1998)

All this creates a therapeutic alliance. (Klein et al., 2003).

Problems occur when gender and culture are ignored; Asian-American 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).