Why should modern psychotherapists be interested in philosophy, especially ancient philosophy? Why should philosophers be interested in psychotherapy? There is a sense of mutual attraction between ...what are today two thoroughly distinct disciplines. However, arguably it was not always the case that they were so distinct. Donald Robertson takes the view that by reconsidering the generally received wisdom concerning the history of these closely-related subjects, we can learn a great deal about both philosophy and psychotherapy, under which heading he includes potentially solitary pursuits such as self-help and personal development.
Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as ..."empirically supported" and "evidence based." In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings.
Component studies compare standard treatments to treatments with added components or dismantled components. A previous meta-analysis (Ahn & Wampold, 2001) failed to find any differences in outcome ...between treatments with more components and those with fewer components, leading the authors to conclude that common factors and not specific ingredients account for therapeutic change.
The current random effects model meta-analysis of psychotherapy component studies conducted between 1980 and 2010 included more than 3 times as many studies as Ahn and Wampold's (2001) meta-analysis (k = 66). Unlike the previous meta-analysis, this study conducted separate meta-analyses for additive and dismantling studies and also examined treatment outcomes at follow-up.
For the dismantling studies, there were no significant differences between the full treatments and the dismantled treatments. For the additive studies, the treatment with the added component yielded a small, but significant, effect at completion (d = 0.14) and a slightly larger effect at follow-up (d = 0.28), but only for the specific problems that were targeted for treatment. Despite the diversity of populations studied, problems treated, and treatments examined, there was little heterogeneity among the results of these studies.
These findings suggest that added specific ingredients may contribute modestly to treatment outcomes.
The therapeutic alliance has been found to predict psychotherapy outcome in numerous studies. However, critics maintain that the therapeutic alliance is a by-product of prior symptomatic ...improvements. Moreover, almost all alliance research to date has used differences between patients in alliance as predictor of outcome, and results of such analyses do not necessarily mean that improving the alliance with a given patient will improve outcome (i.e., a within-patient effect). In a sample of 646 patients (76% women, 24% men) in primary care psychotherapy, the effect of working alliance on next session symptom level was analyzed using multilevel models. The Clinical Outcomes in Routine Evaluation-Outcome Measure was used to measure symptom level, and the patient version of the Working Alliance Inventory-Short form revised (Hatcher & Gillaspy, 2006) was used to measure alliance. There was evidence for a reciprocal causal model, in which the alliance predicted subsequent change in symptoms while prior symptom change also affected the alliance. The alliance effect varied considerably between patients. This variation was partially explained by patients with personality problems showing stronger alliance effect. These results indicate that the alliance is not just a by-product of prior symptomatic improvements, even though improvement in symptoms is likely to enhance the alliance. Results also point to the importance of therapists paying attention to ruptures and repair of the therapy alliance. Generalization of results may be limited to relatively brief primary care psychotherapy.
Rates of Change in Naturalistic Psychotherapy Baldwin, Scott A; Berkeljon, Arjan; Atkins, David C ...
Journal of consulting and clinical psychology,
04/2009, Letnik:
77, Številka:
2
Journal Article
Recenzirano
Most research on the dose-effect model of change has combined data across patients who vary in their total dose of treatment and has implicitly assumed that the rate of change during therapy is ...constant across doses. In contrast, the good-enough level model predicts that rate of change will be related to total dose of therapy. In this study, the authors evaluated these competing predictions by examining the relationship between rate of change and total dose in 4,676 psychotherapy patients who received individual psychotherapy. Patients attended 6.46 sessions on average (
SD
= 4.14, range = 3-29,
Mdn
= 5). The results indicated that although patients improved during treatment, patients' rate of change varied as a function of total dose of treatment. Small doses of treatment were related to relatively fast rates of change, whereas large doses of treatment were related to slower rates of change. Total dose had a nonlinear relationship with the likelihood of clinically significant change. Given the variability in rates of change, it appears that time limits for treatment uniform to all patients would not adequately serve patients' needs.
Expertise in Psychotherapy Tracey, Terence J. G.; Wampold, Bruce E.; Lichtenberg, James W. ...
The American psychologist,
04/2014, Letnik:
69, Številka:
3
Journal Article
Recenzirano
It has been argued that psychotherapy is a profession without any expertise (Shanteau, 1992). We examine the validity of this claim, reviewing the literature on expertise, clinical decision making, ...and psychotherapeutic outcome assessment, and find it a reasonable assessment. There is no demonstration of accuracy and skill that is associated with experience as a therapist. We posit that this absence of an expertise-experience relation is attributable to therapists' lack of access to quality outcome information regarding their interventions and an overreliance on fallible information-processing strategies even when such outcome information is available. The research on providing outcome feedback is reviewed, and although it does relate to client improvement, it has not been shown to be associated with any gains in therapist skill or expertise. We propose a model of outcome information usage and specific a priori hypothesis testing as a means of developing expertise.
Psychodynamically based brief psychotherapy is frequently used in clinical practice for a range of common mental disorders in children and adolescents. To our knowledge, there have been no ...meta-analyses to evaluate the effectiveness of these therapies.
After a broad search, we meta-analyzed controlled outcome studies of short-term psychodynamic psychotherapies (STPP, 40 or fewer sessions). We also performed sensitivity analyses and evaluated the risk of bias in this body of studies.
We found 11 studies with a total of 655 patients covering a broad range of conditions including depression, anxiety disorders, anorexia nervosa, and borderline personality disorder. STPP did not separate from what were mostly robust treatment comparators, but there were some subgroup differences. Robust (g = 1.07, 95% CI = 0.80-1.34) within group effect sizes were observed suggesting the treatment may be effective. These effects increased in follow up compared to post treatment (overall, g = 0.24, 95% CI = 0.00-0.48), suggesting a tendency toward increased gains. Heterogeneity was high across most analyses, suggesting that these data need be interpreted with caution.
This review suggests that STPP may be effective in children and adolescents across a range of common mental disorders.
Somatic symptom disorders are common, disabling and costly. Individually provided short-term psychodynamic psychotherapies (STPP) have shown promising results. However, the effectiveness of STPP for ...somatic symptom disorders has not been reviewed.
We undertook a systematic review of randomized controlled trials and controlled before and after studies. The outcomes included psychological symptoms, physical symptoms, social-occupational function, healthcare utilization and treatment continuation.
A total of 23 studies met the inclusion criteria and covered a broad range of somatic disorders. Thirteen were RCTs and 10 were case series with pre-post outcome assessment. Of the included studies, 21/23 (91.3%), 11/12 (91.6%), 16/19 (76.2%) and 7/9 (77.8%) reported significant or possible effects on physical symptoms, psychological symptoms, social-occupational function and healthcare utilization respectively. Meta-analysis was possible for 14 studies and revealed significant effects on physical symptoms, psychiatric symptoms and social adjustment which were maintained in long-term follow-up. Random-effect modeling attenuated some of these relationships. There was a 54% greater treatment retention in the STPP group versus controls.
STPP may be effective for a range of medical and physical conditions underscoring the role of patients' emotional adjustment in overall health. Future research should include high-quality randomized and clinical effectiveness studies with attention to healthcare use and costs.
Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically ...supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
OBJECTIVE: The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD. METHOD: Data on variables not previously meta-analyzed such as ...inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined. RESULTS: Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability. CONCLUSIONS: The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.
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