PSY31001 CLINICAL PSYCHOLOGY
Lecture 1
Difficulties in evaluating treatment
- Erwin (2000) describes how different theoretical approaches to treatment use
different criteria to judge outcomes
- Those using CBT typically use elimination of symptoms as the main criteria of success
- Behavioural therapists view the modification of behaviours as important
- Psychodynamic therapists view elimination of unconscious conflicts as critical to
success
- Humanistic psychotherapists see enhancement of personal autonomy as main
therapeutic objective
Spontaneous remission
- Mental health problems can be by nature, transitory. It can be argued that those
with mental health problems will get better over time without receiving specific
treatment. It is estimated around 30% of those with diagnosed anxiety or mood
disorders will get better without structured treatment.
Placebo effect
- May be the case that many psychological treatments have beneficial effects because
the patient expects them to work. The positive gains of the placebo effect are short
lived and structured psychotherapies lead to greater improvement.
Dodo bird verdict
- Rosenzweig 1936 supposed that the common actors across psychotherapies were so
pervasive that there would be only small differences in outocmes of comparisons of
different forms of psychotherapy.
- In 1975 Luborsky, Singer, and Luborsky examined about 100 comparative treatment
studies and found that Rosenzweig’s hypothesis was essentially correct.
- As early as 1936 Saul Rosenzweig had labelled this effect the Dodo Bird Verdict
(Rosenzweig, 1936) after the bird in Lewis Carroll’s Alice’s Adventures in
Wonderland. In that story, a number of animals had become wet and in order to dry
themselves ran round the lake to see who could get dry first. No one measured how
far they’d run or for how long, but when asked who had won, the dodo said
‘Everybody has won and all must have prizes’!
- The term “Dodo bird verdict” has since become commonly used, and researchers
have continued to argue for and against this principle.
, FOR dodo bird verdict AGAINST dodo bird verdict
- Those who agree with the Dodo Bird - Improvements in statistical analyses
Verdict claim that all now allow us to make fine-grained
psychotherapies are equally distinctions between the
effective because they all contain effectiveness of different therapies
some important common factors in a way that we could not do
that are shared across all previously (Chambless & Hollon,
psychotherapeutic interventions. 1998; Otte, 2011)
- Common Factors Theory: - Research suggests that some
Grencavage & Norcross (1990) psychotherapies are more effective
identified up to 35 common factors for some mental health problems
across psychotherapies that than for others (Siev & Chambless,
influence therapeutic outcome. 2007, 2009)
They divided these into five main - Several studies (Beutler et al, 1991;
groups: Blatt, 1992; Blatt & Folsen, 1993;
- client characteristics Blatt & Ford, 1994) have shown that
- therapist characteristics the match of the patient’s
- the change process personality with different
- treatment structures treatments can then succeed in
- therapist–client relationship producing significant effects;
elements. - We not only have to consider
whether interventions are effective
- One of the most important common in treating psychopathology
factors affecting outcome is the symptoms, we also have to consider
therapeutic alliance (Lambert, 1992; whether they might also be harmful
Del Re, Flückiger, Horvath, Symonds in the sense that they may evoke
& Wampold, 2012). negative responses to treatment in
- Wampold, Minami, Baskin & Tierney some clients or client groups (e.g.
(2002): 7% of variability in individuals diagnosed with
treatment outcome was due to the substance dependency) (Dimidjian
therapeutic alliance, vs only 1% & Hollon, 2010).
attributable to the principles -
inherent in the type of
psychotherapy being deployed.
-
Meehl reviewed 22 studies comparing clinical and statistical prediction. The results
indicated that statistical predication was preferable. He then followed this up in 1965;
examining 51 studies that compared clinical and statistical prediction. These investigations
almost uniformly confirmed his earlier conclusion: Statistical prediction essentially always
worked at least as well, and usually worked better, than clinical prediction.
,Grove and Lloyd (2006) surveyed a 10% random sample of American Psychological
Association Clinical Psychologists to learn how familiar they were with the controversy, their
views on the matter, and their clinical practices. Of 183 participants:
• <15% had never heard of the controversy or had merely heard that it
existed
• 42% had covered the controversy in detail during their training
• 10% had not been taught that there were any available statistical
prediction methods, let alone what they were or how to use them
• 6% had only had the existence of such methods mentioned.
Therapist drift
- When we are delivering an evidenced based treatment, we often deviate from the
model itself.
- ‘our failure to deliver treatments that we have been trained to deliver, or failure to
deliver treatments adequately’.
- Research in the world of CBT – where substantial inter-therapist differences in how
this model is delivered has been found across a range of disorders.
Therapist effectiveness over time
- Goldberg et al 2016 examined changes in psychotherpists outcomes over time using
a large, longitudinal, naturalistic psychotherapy data set
- Patient-level outcomes were examined using the outcome questionnaire-45.
Patients completed the measure at initial assessment and prior to each session.
Respondents rate the frequency at which each event occurred on a five point likert
type scale. The OQ-45 items were developed to assess symptom distress,
interpersonal relationships and social role functioning.
- The relationship between therapist experience and patient pre-post scores and early
termination was examined.
- Results:
- Therapists achieved outcomes comparable with benchmarks from clinical trials.
- A very small but statistically significant change in outcome was detected indicating
that on the whole, therapists’ patient outcome tended to diminish as experience
(time or cases) increases.
- This small reduction in pre-post change remained when controlling for several
patient-level, caseload-level, and therapist-level characteristics, as well as when
excluding several types of outliers.
- Further, therapists were shown to vary significantly across time, with some
therapists showing improvement despite the overall tendency for outcomes to
decline.
- In contrast, therapists showed lower rates of early termination as experience
increased.
- Curiously, the results of the present study contrast with clinician self-reported
experience. In a large, 20-year, multinational study of over 4,000 therapists, Orlinsky
and Rønnestad (2005) found that the majority of practitioners experience
themselves as developing professionally over the course of their careers.
-
, Lecture 2
IAPT
- Improving access to psychological therapies established in 2008
- New therapists trained in cognitive behavioural therapy
- From 2011, new top up training for non-cbt modalities
- PCET second most commonly delivered therapy in IAPT
- Outcomes for depression broadly equivalent to CBT
Person centred experiential therapy
- Counselling model in the humanistic tradition integrating the person centred
approach with elements of emotion focused therapy
- PCET prioritises the therapeutic relationship where the therapist offers carl rogers
core conditions
- Core conditions = necessary and sufficient conditions of therapeutic personality
change i.e congruence, unconditional positive regard and empathy *REG*
- Person centred approach Is non directive, it means therapist trusts client to know
what they need and the client directs the therapy. Therapist might tentatively offer
an intervention but it’s up to the client to engage with it
- Tracking process and content (content = what people talk about, process = how
people talk)
Emotion focused therapy
- From emotion focused therapy, PCET adds an understanding of the role of emotion
in psychological distress and a variety of interventions to guide the clients process
Emotion theory
- Emotions have evolved to help us survive for example, hunger drives us to find food,
fear drives us to find safety and love drives us to find others
Emotion scheme
