L3: Does Psychotherapy work?

Question 1

What are the two main reasons psychotherapists must be accountable in providing empirically-supported treatments?

Answer 1

• Ethics

- Need to provide justification to clients and third-party payers, e.g. Medicare, insurance companies

Question 2

What non-specific factors could be responsible for improvements in clients receiving psychotherapy?

Answer 2

• Therapist-client alliance
• improved client motivation and hope
• therapist empathy and general counselling skills

Question 3

What are the two criteria for “well-established” treatments?

Answer 3

• At least two good between-group design experiments (Randomised Control Trials) must demonstrate that the treatment is superior to
• placebo pill
• placebo psychotherapy
• other treatment that is ineffective

OR

• treatment is equivalent to an already established treatment, with adequate sample size and power

Question 4

What are six characteristics of a “good” experimental design in EST?

Answer 4

• Random allocation of participants to treatment groups
• Blind or double blind design
• Experiment must be conducted with treatment manuals, or clear description of treatment, to enable replication
• characteristics of samples must be specified (e.g. diagnoses, exclusion criteria)
• characteristics of therapists must be specified (e.g. experience, training)
• Effect must be demonstrated by at least two different investigator teams

Question 5

Why must all clinical trials now be registered?

Answer 5

To avoid publication bias, by having the results of all clinical trials publicly available.

Question 6

What are the two criteria for “probably efficacious” treatments?

Answer 6

• At least two studies experiments show the treatment is superior to a wait-list control

OR

• meets well-established criteria, but experiments not carried out by two different teams

Question 7

Which treatments are classified as “experimental”?

Answer 7

Those not yet tested in randomised control trials with adequate methodology.

Question 8

What are the four major criticisms of the EST approach?

Answer 8

• Reliance on DSM to describe samples
• Reliance on randomised controlled trials
• Reliance on treatment manuals
• lack of generalisability to ordinary treatment settings

Question 9

Expand on the criticism of reliance on the DSM to describe samples.

Answer 9

• Some claim diagnostic labels are dehumanising
• Or that the medical model is not appropriate
• BUT, there must be a way to describe and generalise samples

Question 10

Expand on the criticism of reliance on treatment manuals.

Answer 10

• Some claim this reduces treatment quality because treatment is not tailored to the individual
• Supposedly reduces generalisability, because clinicians don’t normally use treatment manuals
• BUT data do not support the view that manuals reduce quality of treatment, and can increase effectiveness of younger therapists

Question 11

Expand on the criticism of reliance randomised controlled trials.

Answer 11

• Some claim this advantages behavioral and cognitive treatments, because these are more easily measured than e.g., psychoanalytic and humanistic treatments.
• BUT it is not clear if an alterantive to RCT’s in demonstrating treatment efficacy is available.

Question 12

Expand on the criticism of lack of generalisability to ordinary clinical settings.

Answer 12

Would the findings of EST research be replicated in private practices, community health settings?

• would they be replicated with an unselected client base, without applying exclusion criteria?
• In clinical settings where mental health workers include less experienced therapists, mental health nurses and social workers with less rigorous psychological training?
• research shows some evidence of generalisability, but effect sizes smaller in natural settings.