Psychotherapy Research

Question 1

Eysenck

Answer 1

known for factor analysis; wrote 1952 article on psychotherapy outcome in which he found that 72% of untreated neurotic individuals improved without therapy, while 66^ of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic psychotherapy showed a substantial decrease in symptoms; concluded that any apparent benefit of therapy is due to spontaneous remission

Question 2

Meta-analysis

Answer 2

used to combine the results of multiple studies and involves calculating an effect size

Question 3

Effect size

Answer 3

converts the data from different studies to a common metric so that results can be quantitatively combined and compared

calculation of an effect size usually involves subtracting the mean outcome score of the control (or other comparison) group from the mean outcome score of the treatment group and dividing the difference by the standard deviation of the control group

Question 4

Smith, Glass, & Miller (1980)

Answer 4

used meta-analysis to combine the results of 475 outcome studies published between 1941 and 1976 and obtained a mean effect size of .85; which indicates that, at the end of therapy, the average therapy client is better off than 80% of those who need therapy but remain untreated

Question 5

Lipsey & Wilson (1993)

Answer 5

conclude that effect size estimates for psychological treatments equal or exceed those for medical and educational interventions and are sufficiently large to support the claim that psychological treatments are generally efficacious in practical as well as statistical terms

Question 6

Lambert & Bergin (1994)

Answer 6

positive change in therapy is not due to any unique or specific techniques but, instead, to factors that the various treatments share in common (e.g. catharsis, therapeutic alliance, behavioral regulation, and cognitive learning/mastery)

Question 7

Howard and his colleagues (1996)

Answer 7

indicates that the relationship between treatment length and outcome “levels off” as about 26 sessions; referred to as dose-dependent effect

Question 8

Howard et al. phase model

Answer 8

predicts that the benefits of treatment vary, depending on number of sessions; effects of therapy can be described in terms of three stages that are related to the length of treatment:

• remoralization- a client’s feelings of hopelessness and desperation respond quickly to therapy
• remediation- focus is on the symptoms that brought client to therapy; symptompatic relief usually requires about 16 sessions
• rehabilitation- focuses on “unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life

Question 9

Efficacy vs. effectiveness research

Answer 9

efficacy studies- clinical trials
effectiveness studies- correlational or quasi-experimental in nature

• strict experimental control required by efficacy studies limits the generalizability of their results
• efficacy studies are most useful for establishing whether or not a treatment has an effect, while effectiveness studies are best for assessing clinical utility (generalizability, feasibility, and cost-effectiveness

Question 10

Sue (1991)

Answer 10

Clients from all groups were likely to show improvement in Global Assessment Scale but that Hispanic American clients had the best outcomes followed, in order, by Anglo, Asian, and African American clients

Question 11

Utilization of Mental Health Services

Answer 11

the utilization rates of mental health services differ for different racial/ethic groups, type of treatment setting, and type of problem

Question 12

Premature termination rates

Answer 12

overall, members of ethnic and cultrual minority groups are more likely than Whites to terminate therapy prematurely; 50% of racial/ethnic minority groups dropout after the first session compared to 30% of White clients; African Americans had a higher premature dropout rate than Whites, Asians had a lower rate; Hispanic had a rate similar to that of Whites

Question 13

Therapist-client matching

Answer 13

• inconclusive results
• ethnic matching reduced premature termination rates for Asian, Hispanic, and White Americans but not for African Americans and that matching was associated with improved treatment outcomes for Hispanics only
• 2002 study concluded that ethnic matching has a small, but not significant, positive effect on number of therapy sessions attended

Question 14

Most common mental health problems among older adults = APA 2002

Answer 14

anxiety, severe cognitive impairment, depression

Question 15

Treatments for older adults

Answer 15

1. behavioral and environmental interventions have been well-established as effective approaches for older adults for behavior problems associated with dementia
2. memory and cognitive retraining have been found “probably efficacious” for patients with dementia
3. cognitive behavioral and brief psychodynamic therapies have been shown to be probably efficacious as treatments for depression

Question 16

Victims of Spousal/Partner Abuse

Answer 16

Women are more likely to be victims when they are younger, heterosexual, American Indian/Alaskan native (followed by African American) and in families that have yearly incomes less than $10,000

Family income was the best single predictor of cessation of battering

Conjoint couples therapy may be helpful when abuse is expressive (primarily the expression of emotion, is mutual or reciprocal, and is followed by remorse), but contraindicated when abuse is instrumental (committed without provocation and to achieve a goal, is unilateral, and is not followed by remorse

Question 17

Factors affecting the decision to remain in an abusive relationship

Answer 17

Woman’s commitment to relationship– the more emotionally attached to the batterer, are desirous of saving the relationship, or have been in the relationship for an extended period of time are more likely to stay

Other factors include economic dependence, a belief that the batterer will change, and fear that the batterer will retaliate against the woman and/or children if she leaves

Question 18

Treatment Manuals

Answer 18

were originally developed to standardize psychotherapeutic treatments so their effects could be empirically evaluated and to provide guidelines for training therapists

cons- oversimplify therapeutic process and can lead to the misuse of therapeutic techniques

pros- help disseminate info about empirically validated treatments and capitalize on tan actuarial approach to clinical decision making and avoid pitfalls of clinical judgment

Question 19

Placebo effect

Answer 19

participants in placebo conditions typically show greater improvement in symptoms than those in no-treatment or wait-list control groups

ongoing debate is whether or not placebo controls make sense in psychotherapy research. Critics argue that not useful and has not helped identify the “active ingredients” of psychotherapy

Question 20

Diagnostic overshadowing

Answer 20

originally used to describe the tendency of health professionals to attribute all of a person’s psychiatric symptoms to his or her intellectual disabilities. Subsequent research has shown that diagnostic overshadowing is not related to a professional’s theoretical orientation, expertise, or experience and that it applies to other conditions, diagnoses, and situations

Question 21

Vocational overshadowing

Answer 21

a professional overlooks a client’s vocational problems because the client has a co-existing personal problem

Question 22

Alloplastic intervention

Answer 22

goal is to make changes in the environment so that it better accommodates the individual

Question 23

Autoplastic intervention

Answer 23

goals to change the individual so that he/she is better able to function effectively within his/her environment

Question 24

Therapist Distress

Answer 24

74. 3% of participants said they had experienced personal distress in past 3 years
75. 7% saying it decreased the quality of their work
76. 6 admitting it resulted in inadequate treatment

Question 25

Therapist Work Related Problems

Answer 25

1. suicidal statements are most stressful type of client behavior
2. lack of therapeutic success most stressful aspect of work
3. issues related to confidentiality constitute the most frequently encountered ethical/legal dilemma

Question 26

Psychiatric Hospitalization

Answer 26

mental illness is higher among females than males in each age group
however, admission rates to psychiatric hospitals have more men; men are more likely to act out and be considered threatening by society

Question 27

Psychiatric Inpatients

Answer 27

Marital satus- admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married

Race/ethnicity- although whites represent the largest number of psychiatric inpatients when population proportions are taken into account, patients from other races are overrepresented

Age- for both men and women, the largest proportion of admissions is in the 25 to 44 age range

Diagnosis- schizophrenia is the most common diagnosis for inpatients in the 18-44 range; for ages 65+, an organic disorder is the most common diagnosis followed by an affective disorder