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Psychotherapy, psychotherapy research, and translating science into practice
In the field of psychotherapy, what works for children, adolescents and adults?
Origins of psychotherapy
Origin dates back thousands of years, but the way it is currently practiced is no more than a
hundred years old
May be traced to Socrates and the classical Greek philosophers
Sigmund Freud: central role in establishing modern psychotherapy as a discipline and
profession
Psychotherapy lead to the development of the humanistic, cognitive behavioral and
systematic psychotherapy traditions
Psychotherapy traditions
Over 400 schools of psychotherapy, more than a dozen approaches
Psychodynamic psychotherapy:
o < Freud
o “Psychological disorders arise from unresolved unconscious conflicts and the
associated use of maladaptive defence mechanisms”
o Free association and interpretation to help understand the unconscious
o Goals: character change and symptom alleviation
Humanistic psychotherapy:
o Rogers (client-centred), Fritz (gestalt therapy) and experiential therapies
o “Avoidance or denial of current feelings, emotions, desires + deliberate or
inadvertent failure to take responsibility for these aspects prevents personal growth
and give rise to psychological symptoms”
o Therapeutic relationship between client and therapist
o Helping clients to become more fully aware of/take responsibility for their
immediate feelings, emotions, wishes (which may be out of their normal awareness)
o Goal: personal growth
Cognitive behavioural therapy:
o Within the traditions of learning theory and cognitive science
o John Watson (behaviour therapy) and Aaron Beck (cognitive therapy)
o “psychological problems are learned and maintained by cognitive and behavioural
social learning processes, which often operate outside awareness”
o Use of highly specific treatment procedures for specific problems
o Strong collaborative therapeutic relationship between clients and therapist
o Goal: resolving presenting problems
Systematic therapy
o Working directly with couples, parents, families and social networks
o Bateson
o “psychological problems may arise for a variety of reasons, but may be inadvertently
maintained by the way clients interact with members of families and social systems,
and the belief systems that underpin these interaction patterns”
, o Conjoint involvement of the client and members of their family or social system in
understanding the problems
o Goal: resolving presenting problems and enhancing relationships within the family
and social system
Psychotherapy integration:
Combining constructs from different theories into more complex frameworks
Provide coherent rationales for employing a variety of clinical techniques
Focus attention on critical factors common to many forms of psychotherapy
Psychotherapy modalities:
Group therapy benefits: group support, feedback, problem solving
Definition of psychotherapy:
Contractual process in which trained professionals interact with client to help them resolve
psychological problems and address mental health difficulties
To children and adults, on an individual/couple/group basis
Psychological interventions = specific psychotherapeutic practices
Psychotherapy contract:
Therapist and clients agree to fulfil certain roles:
o Therapist’s role: offer client a service in a professional and skilled manner + adhere
to ethical standards to maintain the client’s best interests
o Client’s role: co-operate with treatment procedures + agreeing to address
ambivalence about problem resolution when this occurs
o Fees: agreed sessional fee paid by the client of health insurance company
Psychotherapy training:
Coursework:
o Material on how to conceptualize psychological problems and mental health
difficulties; interpreting research findings; conducting psychotherapy
Self-reflection:
o Participation in personal psychotherapy
Supervised clinical practice:
o Working with clients under the guidance of a trained therapist
Continuing professional development:
o Supervision of cases by more experienced therapists of peer supervision; reading
professional journals; attending professional conferenced and trainings
,Ethics:
Professional psychotherapy association + adhere to code of ethics
Statutory registration:
Therapists must be licensed to legally practise their profession
Psychotherapy and counselling:
Both involve engaging clients with psychological problems in a therapeutic relationship, with
a view to problem resolution
Psychotherapists: more training, broader training programs
Psychotherapy and mental health professions:
Mental health professions (psychology, social work, psychiatry, psychiatric nurses): many
offer a psychotherapy service but the remits cover a variety of other elements besides
psychotherapy
Psychotherapy in multimodal treatment programmes:
Clients mat be offered psychotherapy alongside of pharmacotherapy or other psychical
treatments
Psychotherapy research:
= systematic inquiry into the process and outcome of interventions conducted to alleviate
psychological problems
Research may be organized into a hierarchy
Evidence-based practice:
Judicious and compassionate use of the best available scientific evidence to make decisions
about client care
Taking account of available scientific evidence, and clients’ unique problems and needs
Hierarchy of evidence:
Least to most persuasive:
o Uncontrolled case studies
o Single group outcome studies
o Controlled trials / controlled single case experiments
o Narrative reviews of controlled trials
o Meta-analysis of controlled trials
, Evidence-based practice and practice-based evidence
Efficacy studies are one source of scientific information for evidence based practice
indicate how well treatments work under ideal conditions
Practice-based evidence: can scientifically inform practice / indicates how well treatments
work under routine conditions
PBE: a standard assessment is completed before treatment and after treatment
Translating scientific evidence into clinical practice:
No single correct process a number of solutions have been proposed
At one extreme: those who favour the identification of specific empirically supported
treatment protocols, using stringent criteria, which take into account highly specific types of
evidence
At the other extreme: those who support the use of multiple sources of evidence to inform
the development of general practice guidelines with differing strength of implication for
practice
Empirically supported treatments:
Chambless criteria: list of empirically supported treatments (ESTs)
Used to evaluate psychological treatments based on the weight of empirical support from
efficacy studies
Distinction between well established treatments and those which are probably efficacious
Are ESTs suitable for routine practice?
ESTs have been criticized for being brief, manualized interventions; unsuited to the multiple
needs of routine clients with complex co-morbid problems and issues of diversity
ESTs can be transported into routine clinical settings, with positive impacts; but less positive
than in randomized controlled efficacy trials
Slightly more effective than treatments which do not meet the Chambless criteria for being
empirically supported
Why so few psychodynamic, systemic, and humanistic ESTs?
Most ESTs fall within the cognitive behavioural therapy tradition
Fewer placebo controlled or comparative treatment outcome research trials have been
conducted outside CBT
Criteria for ESTs are restrictive and could disenfranchise therapies which fall outside the CBT
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