abnormal PSYCHOLOGY

Fourth Canadian Edition

Chapter 17Chapter 17Outcomes and Issues in

Psychological InterventionPrepared by:

Tracy Vaillancourt, Ph.D.

Modified by: Réjeanne Dupuis, M.A.

Chapter Outline

• Client Factors Influencing Psychotherapy Outcomes

• General Issues in Evaluating Psychotherapy• Review of Behavioural and Cognitive Therapies • Review of Couples and Family Therapies • Review of Client-Centered Therapy • Review of Psychoanalytic Therapy • Psychotherapy Integration • Review of Community Psychology

Client Factors Influencing Psychotherapy Outcomes

• Expectations about the outcome of therapy – Demoralization hypothesis

• Goals and motivation to change– Motivation Interviewing

• The impact of personality on therapy outcomes• Therapist factors and working alliance

– Therapeutic or working alliance

General Issues in Evaluating Psychotherapy Research

• Therapy as Researched vs. Therapy as Practised– Treatment manuals– Controlled studies

• Exclusion of people on various grounds

• Use of DSM diagnosis and thereby definition of patients as homogeneous

– Efficacy and effectiveness

Evidence-Based Treatment

• Evidence-based treatment or empirically supported therapies– Needs to be:

• Multisite

• Longitudinal

– Process of change, client factors, chronic mental illness, and the study of nondominant clinical paradigms need to be explored

Stepped Care Models

Review of Behavioural and Cognitive Therapies

• Core assumption is that way people construe their world is a major determinant of their feelings and behaviour– Evaluation of Counter-conditioning and Exposure

Methods• Some empirical support

– Evaluation of Operant Methods• Proved successful with a wide range of behavioural

problems

– Generalization and Maintenance of Treatment Effects

Evaluation REBT• Ellis’s rational-emotive behaviour therapy (REBT)

– Emotional suffering is due primarily to unverbalized assumptions and demands people carry around with them as they negotiate their way in life

• Evidence self-reports of general anxiety, speech anxiety, and test

anxiety.– Improves self-reports and behaviour for social anxiety– Inferior to exposure-based treatments for agoraphobia.– May be useful in treating excessive anger, depression, and anti-

social behaviour.– Useful only as part of more comprehensive behavioural programs

for sexual dysfunction. Type A behaviour pattern– Useful as a preventive measure for untroubled people– Appears to achieve effects through in irrationality of thought

Evaluation CT• Beck’s Cognitive Therapy (CT)

– That people in emotional distress operate with schemas that are impossible to live with

– In contrast to Ellis, focuses on the lack of objective evidence that depressed and anxious people have for maintaining their maladaptive schemas

• Evidence– Effectiveness of CT under intensive study for > 25

years– Works for depression

• Treatment response associated with modulated functioning in limbic and cortical regions

– Helps clients change their cognitions

Reflections on CBT

• A return to cognitions

• Restructuring vs. reframing

• Importance of behaviour change in CBT

• Importance of emotions in CBT

• Phenomenological essence of CBT

• Relapse prevention in CBT

• Unconscious factors

• Relationship factors

Review of Couples and Family Therapy

• Basic Concepts and Techniques– Normality of Conflict– From Individual to Conjoint Therapy

• Approaches– Mental Research Institute Tradition– Cognitive-Behavioural Approaches– Integrative Behavioural Couples Therapy– Emotion-Focused Therapy

• Evaluation– Has beneficial effects for many relationship problems

Review of Client-Centred Therapy

• Basic Concepts and Techniques– Basic premise—people can be understood only in terms of

their own phenomenology • They become disordered when they fail to attend to own

inner nature and instead guide behaviour according to others • Places great emphasis on people’s freedom to choose

• Evaluation– Most research focused on relating outcome to personal

qualities of therapists– Results have been inconsistent– Meta-analysis of studies (1978 to 1992) found that clients

were better off after e intervention than about 80% of non-treated people

Review of Psychoanalytic Therapy

• General Issues with Classical Psychoanalysis– Difficult to assess effectiveness– Difficult to distinguish between classical psychoanalysis

and psychodynamic psychotherapy in practice

• Outcomes of Research– Few outcome studies of long-term psychoanalytic

treatment – Studies tend to lack no-treatment control group

• Evaluation of Brief Psychodynamic and Interpersonal Therapies– Outcome Research– Process Research

Psychotherapy Integration

• Eclecticism and theoretical integration in psychotherapy

• Three types of psychotherapy integration – Technical eclecticism – Common factorism – Theoretical integration

• Arguments against premature integration • Meichenbaum’s constructivist CBT model

Community Psychology• Community Psychology—

Reaching out to large populations in an attempt to prevent the onset or spread of a physical illness or a mental disorder

• Mental Health Promotion–

• Techniques– Mass-media campaigns– Instructional programs in

schools

• Universal preventive interventions– Targeted to general public that

has not been identified on basis of individual risk

• Examples of community psychology programs: – Canadian eating-disorder

prevention programs– Canadian programs for the

early detection and prevention of schizophrenia

– School-based programs for the prevention of cigarette smoking

Copyright

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