PSY343 - 1. Intro Flashcards
Psychotherapy
informedand intenMonal applicaMon of clinical methods and interpersonal stances derived from established psychological principles for the purposes of assisMng people to modify their behaviours, cogniMons, emoMons and/or other personal characterisMcs in direcMons that the participants deem desirable
Psychotherapy
processofincreasing awareness of one’s thoughts, emoMons and behaviours in service of decreasing self-defeaMng pakerns and of increasing the ability to make choices in accordance with enlightened self-interest
Psychotherapy
Discover what we want and how to get there
doesn’t privilege one over another
all have same idea that it’s a modification on how we think, feel or act
conducted for purpose of helping client get to goal
Theory (or system)
A consistent perspecMve on human behaviour, psychopathology, and the mechanisms of therapeuMc change.
History of Psychotherapy
Psychotherapy is a clinical method emerged around the year 1900
• Prior to the 1900s, organized religion had tradiMonally dealt with psychological problems
History of Psychotherapy
Many of the basic principles of psychological treatments today evolved from Sigmund Freud’s (1856-1939) wriMngs on psychoanalysis
• Freud’s psychoanalyMc theory emerged in the context of 19th century preoccupaMon with the development of raMonality and science
History of Psychotherapy
Focused on explaining the nature and workings of the human soul, and treaMng psychic ailments through self-analysis (introspecMon), observaMon, and case studies
History of Psychotherapy
In1913,J.B.Watson(1878–1958)redefinedpsychologyby repudiaMng the study of consciousness and the use of introspecMon, which he deemed unscienMfic
• Watson’sbehaviourismarguedthatpsychology“isapurely objecMve experimental branch of natural science. Its theoreMcal goal is the predicMon and control of
behavior” (Watson, 1913, p. 158)
History of Psychotherapy
freud self observation and case studies on feelings
watson not interested in introspection
wanted experimental
examine it objectively in scientific environment
History of Psychotherapy
World War II transformed field of psychology and psychotherapy
• Unprecedented number of neuropsychiatric casualMes and traumaMzed soldiers changed the way psychiatrists understood psychological dysfuncMon
• Psychiatry lost its prior dominion over the provision of psychotherapy as clinical psychology established itself as a bona fide profession
History of Psychotherapy
-after WWII because of immense need, psychologists brought into hospitals and began practicing psychotherapy
used to be relegated to academia
proliferated to professional setting
History of Psychotherapy
Carl Rogers’s (1902-1987) client-centered therapy was the major alternaMve to psychoanalyMc psychotherapy during the first 2 decades following World War II
• In the 1950s, Rogers emphasized therapeuMc process over technique
History of Psychotherapy
Rogers argued that a therapeuMc attude characterized by uncondiMonal posiMve regard, genuineness, and empathic understanding, was necessary and sufficient to mobilize an individual’s self- actualizing tendency
History of Psychotherapy
shifted to client being main focus of treatment
first researchers to ask scientific questions on practice of psychotherapy
research on psychotherapy
History of Psychotherapy
By the 1950s, emerging call to scienMfically evaluate psychotherapy and its effects
• Hans Eysenck, a prominent behaviourist, was a vocal opponent of tradiMonal psychotherapy (i.e., psychoanalysis)
History of Psychotherapy
Eysenck published a 1952 review of the psychotherapy outcome literature and concluded that there was no evidence demonstraMng psychotherapy works
• Eysenck’s findings were heavily criMcized and later proved inaccurate, but contributed to the implementaMon of RCTs to study the efficacy of psychotherapy
History of Psychotherapy
huge blow, but created burst of activity in psychotherapy research
randomized control trials
History of Psychotherapy
The 1960s early saw incredible growth of psychotherapy and psychotherapy research; proliferaMon of therapy approaches
• Psychotherapists were being mostly being trained within three broad clinical approaches: psychodynamic (most common), client centered (rapidly expanding), and behavioral (beginning to emerge)
History of Psychotherapy
The 1970s marked a criMcal paradigm shin towards more intensive analyses and methodological pluralism in the study of psychotherapy
• Increased emphasis on intensively studying psychotherapy process (i.e., how therapy works)
History of Psychotherapy
By the 1980s it became clear that Eysenck was wrong: psychotherapy has a posiMve effect for most recipients
• As psychotherapy became a more acMve field, so too did compeMMon and rivalry among theoreMcal orientaMons, all vying to prove their approach was the most effecMve
History of Psychotherapy
Psychotherapy research began to focus heavily on determining which therapy approach was the most effecMve
History of Psychotherapy
Dodo Bird Verdict: all therapies are likely equivalent in their efficacy; contribuMons to good outcome driven by common factors across the therapeuMc approaches
History of Psychotherapy
Despite the Dodo Bird effect, researchers are sMll interested in determining which therapies are most effecMve and efficacious
• APA Division 12 Task Force on the PromoMon and DisseminaMon of Psychological Procedures established to provide criteria for efficacious treatments for specific disorders and publishes a list of empirically supported treatments (ESTs)
History of Psychotherapy
Argument against ESTs: there are methodological issues with the standards they used for determining validaMon; researchers need to examine process variables, the therapist-paMent relaMonship, and what works best in the therapy relaMonships for specific clients
• The debate over whether the benefits of psychotherapy are due primarily to ingredients shared across therapies or specific to certain therapies conMnues…
History of Psychotherapy
task force interested in manualized systems - limitation not all follow manuals
don’t represent real world therapy
study might say it’s effective but maybe not generalizable
backlash from researchers who criticize how task force approached it
History of Psychotherapy
Current trend in psychotherapy research recognizes the contribuMons of specific, common, and others factors to change in therapy
• Client characterisMcs, therapist characterisMcs, problem characterisMcs (severity, chronicity), and extratherapeuMc forces (life events) can also affect the outcome of therapy
History of Psychotherapy
Paul (2007): The treatment method, the therapist, the relaMonship, the client, and principles of change are all vital contributors to therapeuMc change, and all must be studied
• Comprehensive evidence-based pracMces consider all of these determinants and their opMmal combinaMons
Epistemological AssumpMons in Psychotherapy Research
Empirical or Realist Approaches – emphasizes confirmaMon based on objecMve data and quanMtaMve or staMsMcal analysis
Epistemological AssumpMons in Psychotherapy Research
RaMonalist or Idealist Approaches – emphasizes the subjecMve and interpreMve, and promotes exploratory and qualitaMve approaches to research, such as case studies
Epistemological AssumpMons in Psychotherapy Research
tension on how we derive knowledge on psychotherapy
empirical: operationalization of concepts, pragmatism, privileges objectivity
experiemental method
rationalist:
privilege experience
interviews, narrative approaches
strong tradition of both, but not without inherent tension
mind seen as blank slate, but rationalist see mind as product of our experience
Evaluating the EffecMveness of Psychotherapy
Efficacy studies are randomized controlled trials (RCTs) that compare treatment results to the results from a control condiMon
• Feature well-defined groups of paMents, usually meeMng diagnosMc criteria for a chosen disorder but no others; manualized treatment guidelines to minimize variability between therapists; and random assignment to control and treatment groups
• Greater internal validity (i.e., the ability to draw conclusions about the cause-effect relaMonship between therapy and outcome)by controlling as many aspects of therapy as possible
Evaluating the EffecMveness of Psychotherapy
EffecMveness studies examine intervenMons under circumstances that more closely approach real- world pracMce, with more heterogeneous paMent populaMons, less-standardized treatment protocols, and delivery in rouMne clinical setngs
• Minimal restricMons are placed on the provider acMons in modifying dose, the dosing regimen, or co- therapy, allowing tailored therapy for each subject. IntervenMon studies can be placed on a conMnuum, with a progression from efficacy trials to effecMveness trials
• Greater external validity because their methods beker match therapy that actually takes place in clinics, private pracMces, hospitals, and other realisMc setngs
EvaluaMng the EffecMveness of Psychotherapy
-
EvaluaMng the EffecMveness of Psychotherapy
-
Evaluating the EffecMveness of Psychotherapy
-
EvaluaMng the EffecMveness of Psychotherapy
-
Evaluating the EffecMveness of Psychotherapy
Meta-analyses makes the results of different studies comparable by converMng findings into a common metric, allowing findings to be aggregated or pooled across studies.
• Effect size – the difference between treatment and control groups, expressed in standard deviaMon units:
Evaluating the EffecMveness of Psychotherapy
• An effect size of 1.0 means that the average treated paMent is one standard deviaMon healthier on the normal
distribuMon or bell curve than the average untreated paMent
• An effect size of 0.8 is considered a large effect in psychological and medical research
• An effect size of 0.5 is considered a moderate effect
• An effect size of 0.2 is considered a small effect
Evaluating the Effectiveness of Psychotherapy
Analyses involving group comparisons typically result in two types of effect sizes:
• Differences among group means, with the effect size being the difference between the poskreatment means of two
groups (e.g., treatment and no-treatment groups) divided by the pooled sample of both groups
Evaluating the Effectiveness of Psychotherapy
- A comparison of groups in terms of the odds or probability of an outcome
- An odds raMo (OR) is calculated to determine the associaMon between group condiMon (e.g., treatment and no- treatment) and a binary outcome variable (e.g., the occurrence or non-occurrence of an event, such as relapse).
Evaluating the Effectiveness of Psychotherapy
• QualitaMve Research: Represents a form of narraMve knowing, grounded in everyday experience
Models of Psychopathology
abnormal vs. normal: arbitrary social construction product of our context
context changes questions and answers we’re looking for
Evaluating the Effectiveness of Psychotherapy
- We construct our world through many forms of individual and collecMve acMon: talk and language (stories, conversaMons), systems of meaning, memory, rituals and insMtuMons, etc.
- Primary purpose of qualitaMve methodologies is to develop an understanding of how the social world is constructed
Evaluating the Effectiveness of Psychotherapy
QualitaMve methodologies include: direct observaMons, narraMve interviews, case studies
Evaluating the Effectiveness of Psychotherapy
-Who determines whether a treatment has been effecMve?
• When should outcomes be measured? • How should outcome be measured?
Evaluating the Effectiveness of Psychotherapy
-
Evaluating the Effectiveness of Psychotherapy
-
Evaluating the Effectiveness of Psychotherapy
“Tripartite model” (Strupp (1996) : When evaluaMng therapy outcomes, researchers must take into account different perspecMves:
• Client
• Therapist
• Other relevant stakeholders (e.g., general public, legal system, healthcare system, clients’ family and friends, insurance company)
Evaluating the Effectiveness of Psychotherapy
3 parties that has stake
client: subject
downside on relying on client is unreliable - depending on their own investment
rely on therapist: more reliable, but they can also be biased, doesn’t know client as much, may not match what client thinks
relevant: diff ways of who to ask whether it’s effective
usually asking all these people so you’re not relying on one person
Evaluating the Effectiveness of Psychotherapy
-
Evaluating the Effectiveness of Psychotherapy
Timing makers.
• Immediately aner therapy ends: was there
improvement following treatment?
Evaluating the Effectiveness of Psychotherapy
Long-term follow-up: how long should those therapy benefits last?
• MulMple Mme points over therapy: when does change occur?
Evaluating the Effectiveness of Psychotherapy
Outcome research focuses on the assessment of how well clients funcMon, using measures of symptom remission, behaviour change, improved social and vocaMonal funcMoning, or personality growth
Evaluating the Effectiveness of Psychotherapy
Process research examines specific events that occur within the therapy session between paMent and therapist, or those characterisMcs of therapists, paMents, and therapeuMc techniques that may account for posiMve changes in paMent funcMoning
Evaluating the Effectiveness of Psychotherapy
outcome is multidimensional
can be diff depending on how we’re defining a good outcome
through interviews
through observation
process research: pioneered by carl, taped sessions how therapist affected you
Models of Psychopathology
AssumpMons about what consMtutes psychopathology frame how clinicians formulate cases and proceed to treat them
Models of Psychopathology
• These assumpMons impose a set of parameters about what the clinician views as “wrong” with a person, what needs to change, how possible change is, and how change might take place
Models of Psychopathology
EMology versus DescripMon
• EMology: explanaMons about the determinants of a psychological disorder or condiMon
Models of Psychopathology
Categorical versus Dimensional
• The categorical view is that mental disorders are qualitaMvely disMnct from each other and from normal psychological funcMoning
• The dimensional approach claims that psychopathology is beker viewed as a conMnuum from normal to abnormal
Models of Psychopathology
using theories to elucidate on how we go about treating them
theory on psychopathology influences treatment from the beginning due to approach
road map based on how they got there from the beginning
patterns of relating to oneself, emotions, thoughts
what we see as problematic
Models of Psychopathology
-tension reflects disatisfaction with descriptive approach
etiology: early heavy emphasis on how they developed
focus here heavily embedded in DSM
shift toward descriptive: current system heavy focus in current DSM
but doesn’t tell me root cause, what is it about, how does it become problematic
might miss the the nuance
but we also need heuristics of description
categorical: on or off - medical model which tends to view it as a pathological entity
moving away from this approach
effort to introduce dimensional
tends to create division
dimensional: allows us to place ourselves on a spectrum
boils down to representations or underrepresentations
pragmatically we do need categorical systems to communicate between health care professionals
abnormal vs. normal: decisions about what is normal and abnormal
arbitrary social construction product of our context
we need to ask ourselves where does this definition come from
Models of Psychopathology
-context changes questions and answers we’re looking for
Models of Psychopathology
-
