PPT # 3 Counseling & Psychotherapy today

Question 1

Why does counseling have a high degree of certainty?

Answer 1

1. Psychotherapy is beneficial,
2. Clients improve to clinically significant levels via psychotherapy,
3. Clients in psychotherapy benefit medically – aka. psychotherapy impacts mind and body
4. Psychotherapy can have negative effects on clients

Question 2

Why does counseling have some certainty?

Answer 2

Tx may offer better long term gain than other Tx (aka medication),
a large portion of clients see improvement after 10 sessions and 75% make significant gains after 50 sessions

Question 3

What don’t we know about counseling?

Answer 3

• What therapist factors influence therapy outcomes?
• Are different therapists more “efficient”?
• Can same outcomes be achieved in shorter time?
• What client factors influence therapy outcomes?
• Are there better “candidates” for therapy?
• How does the therapeutic process influence change?

Question 4

How is Psychotherapy studied?

Answer 4

1. Randomized Clinical Trial (RCT)
2. Outcome Studies
3. Process Studies
4. “Moderator” Studies

Question 5

Describe Randomized Clinical Trial (RCT).

Answer 5

• Characterized by control group, randomization, and strict adherence standards.
• Efficacy

Question 6

Describe Outcome Studies.

Answer 6

• Do clients improve after therapy? Usually done in community settings
• Effectiveness: What’s it like in the real world? & Will it work when it matters?

Question 7

Describe Process Studies.

Answer 7

• considers how therapy works and why change happens
• Observing therapy sessions, interviewing clients and therapists, considering many factors relevant to outcomes (beyond symptomology).

Question 8

Describe “Moderator” Studies.

Answer 8

– what factors influence the effectiveness of therapy? - Education

• What context, client factors, therapist factors make therapy more or less effective?

Question 9

What are the steps to establishing an Empirically Supported Treatment (EST)?

Answer 9

1. Identify problem/diagnosis
2. Develop Step-by-Step treatment
3. Manualize Treatment
4. Test for efficacy
5. Re-test for efficacy

Question 10

What did Wampold and Budge (2012) suggest that change in outcomes were due to:

Answer 10

(a) the initial therapeutic bond ***:
(b) the real relationship between client and psychotherapist
(c) the creation of expectations
(d) client participation in healthy actions

Question 11

Describe the model of treatment and responsiveness to treatment.

Answer 11

• Cultural and relational context
• Techniques and interventions offered by therapist
• Client acceptance of techniques and interventions
• Client response and new behavior

Question 12

Describe Cultural and relational context

Answer 12

• Client characteristics: expectations for psychotherapy: Hope for change as change itself - 5-10% improve before 1st appt (Howard, 2001)
• Therapist characteristics
• Relationship factors:

Question 13

Thinking about the cultural and relational context, what are the therapist characteristics?

Answer 13

1. Empathy
2. Positive Regard
3. Affirmation
4. Congruence/Genuineness

Question 14

Thinking about the cultural and relational context, what are the relationship factors?

Answer 14

• Integrates both the relational and technical aspects of therapy
• Strongly associated with outcome across all forms of treatment and intervention
  1. Accommodating therapy to motivational level and readiness for change,
  2. Accommodating therapy to client’s goals and ideas about intervention,
  3. Accommodating the core conditions (values) to fit the client’s definition of those variables.

Question 15

What techniques and interventions offered by therapist?

Answer 15

• Efficacy trials

- Effectiveness Trials

Question 16

Thinking about the techniques and interventions offered by therapist, what does the efficacy trials include?

Answer 16

1. RCTs are the gold standard for clinical research: they have been critiqued on a number of grounds:
   - subjects in RCTs are often not like real psychotherapy patients
   - treatments are too rigid and inflexible
   - RCTs focus on only the presenting and targeted diagnosis

Question 17

Thinking about the techniques and interventions offered by therapist, what does the effectiveness trials include?

Answer 17

• Tend to be conducted in psychotherapy offices within the community
• Allow researchers to answer practical questions

Question 18

Describe client’s acceptance…

Answer 18

Success depends on the client’s degree of compliance

• they must accept the offered techniques and respond to the psychotherapist’s offered intervention.

Question 19

Describe Client response and new behavior

Answer 19

• Counseling must align with client’s “lived experience” –> New actions might disrupt various patterns of behavior that have long endured
• Therapy can go awry if the psychotherapist does not process with the client what is happening in the client’s social world
• Modifying one’s schemas, motivations, and emotions

Question 20

Another aspect of Techniques and interventions is dissemination. Please describe this.

Answer 20

• Once a treatment is determinined effective is needs to be disseminated to the “working class”
  (a) How do people in leadership decide to adopt a specific evidence-based practice?
  (b) How does the practice get disseminated widely through the unit with good treatment fidelity?
  (c) What are the obstacles to wide adoption and use of the evidence-based practice?