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An Evaluation of the Therapeutic Learning Program
Abstract
The Therapeutic Learning Program (TLP) is a structured, model-based treatment designed to help clients counter self-doubts that interfere with personafdevelopment. Specific information is collected and a therapist helps the client interpret it, select goals, and overcome emotional barriers to action. Undergraduate volunteers (N = 66) seeking counseling to solve academic problems were randomly assigned to a condition in which they entered TLP information on a computer (TLP1), a condition in which they entered the TLP information on a paper check list (TLP2), or participated in a personally chosen option (PCO) control. The post-test data showed equal satisfaction and setf-concept gain for all three treatments. Sessions with the computer were longer, involved the clients in more individual effort, and were probably more thorough.
... Such an approach has been applied to crisis counseling (Seabury, 1993 ), behavioral counseling (Engen et al., 1994) and family interventions (Maple, 1994 ). Similar approaches have been developed for training professionals in field settings (Leung, Cheung, and Stevenson, 1994; Patterson et al., 1997; Satterwhite and Schoech, 1995), as well as for educating clients (Oakley, 1994; Olevitch and Hagan, 1994; Wark et al., 1991; Weisman, 1994). These approaches and programs could probably be adapted fairly easily for classroom use. ...
In spite of the dramatic increase in the volume of information on computer technology in social work, very little has been written about how this technology might be incorporated into existing curricula. What is needed is an overview of how computers have been used in social work practice and in educational settings that can serve as a starting point for social work faculty who are in the process of computerizing aspects classes and curricula. An extensive survey of the literature explored and classified literature on computing in social work by teaching style and curriculum content area. The authors discuss these approaches and consider how computer applications developed for practice settings might be adapted and incorporated into social work educational settings.
... There were several reported benefits for clients in the use of computers in therapy. However, there were also risks associated with computer-assisted therapy, especially when computer software packages were developed for client use and did not require the presence of a therapist (Bloom, 1992; Ford, 1993; Wark, Kalkman, Grace, & Wales, 1991; Zarr, 1994). Unanticipated effects of this form of self-help could produce marked distress for some people. ...
Thesis (Ph. D.)--Virginia Polytechnic Institute and State University, 1996. Vita. Abstract. Includes bibliographical references (leaves 109-116). Photocopy. s
The concepts, rationale, potential, methods, and test results of the self-paced interactive PLATO computer-based Dilemma Counseling System (PLATO DCS) are presented. A pre–postexploratory experimental test of PLATO DCS was conducted in which 41 undergraduates were taught to use the system for their own problems; 36 undergraduates served as controls. PLATO DCS counseling resulted in greater improvement in the clients than did counseling in a control condition. Solutions generated by PLATO DCS were generally of high quality. Neuroticism was positively correlated with greater problem improvement, remaining involved with the computer, and more favorable evaluation of PLATO DCS. (42 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The rationale for using computers in psychotherapy includes the possibility that therapeutic software could improve the efficiency of treatment and provide access for greater numbers of patients. Computers have not been able to reliably duplicate the type of dialogue typically used in clinician-administered therapy. However, computers have significant strengths that can be used to advantage in designing treatment programs. Software developed for computer-assisted therapy generally has been well accepted by patients. Outcome studies have usually demonstrated treatment effectiveness for this form of therapy. Future development of computer tools may be influenced by changes in health care financing and rapid growth of new technologies. An integrated care delivery model incorporating the unique attributes of both clinicians and computers should be adopted for computer-assisted therapy.
Approximately two dozen efforts in the published literature to deliver counseling or other psychological intervention services are critically reviewed, and several issues considered basic to significant progress are discussed. Primary attention is given to examining the use of computers in cognitive psychotherapy, games, computer-aided instruction, biofeedback and behavior therapy, and other related approaches to psychotherapy. Evidence presented in this review leads to the conclusion that computers can make meaningful contributions to the treatment of psychological problems. The limited ability of current computer programs to process natural language is highlighted as the most significant impediment to continued progress in this area.
Recent computer-assisted counseling systems have been designed to treat specific types of psychological problems for which clearly articulated treatment strategies are available. Examples of such systems are MORTON, a program designed to treat mild to moderate depression, and PLATO DCS, a program for the treatment of moderately difficult avoidance-avoidance dilemmas. PLATO DCS and MORTON might be valuable for training counselors in treatment strategies for dealing with dilemmas and depression. In addition, counselor trainees can respond to these systems as clients and can use them as consultants. Computerization of other counseling techniques might lead to significant theoretical advances because technique must be clearly and concisely articulated to make computer applications feasible. Possible limitations of computer-assisted counseling are discussed, including client and counselor acceptance of computers as therapists and the limited ability of the computer to understand natural language.
The use of computers in psychiatry and psychology is reviewed. It is noted that computers are already being used successfully
for consultation, interviewing, and continuing education. Issues related to the usage of computers in mental health are discussed.
Guidelines for future work in the area are suggested.
The increasing sophistication of computer technology, combined with increased specification of therapeutic interventions,
has facilitated development of computer programs that have achieved marked success in the psychotherapeutic treatment of circumscribed
populations. This paper briefly reviews the history of computerized psychotherapy and examines several successful therapeutic
computer applications in depth. These applications have attempted to replace the therapist with a computer. Another possible,
as yet unexplored, application is the use of the computer as a vehicle for modification of an individual’s perceived competence
to effectively operate on his or her environment. Using a computer to successfully manipulate one’s environment can provide
a personal mastery experience that has the potential to contribute significantly to an increase in perceived self-competence,
an essential component of positive therapeutic change. A study that would provide empirical support for this type of computer
application is proposed.
The authors evaluated a six-session interactive computer cognitive-behavioral treatment program given to volunteer patients who met Research Diagnostic Criteria (RDC) for major or minor depressive disorder. Patients were randomly assigned to computer-administered cognitive-behavioral treatment, to therapist-administered cognitive-behavioral treatment, or to a waiting-list control condition. After treatment and at 2-month follow-up, both treatment groups had improved significantly more than control subjects in their scores on the Beck Depression Inventory, SCL-90-R depression and global scales, Hamilton Rating Scale for Depression, and Automatic Thoughts Questionnaire. The treatment groups did not differ from each other at either time.
To establish the feasibility of using computers to interview suicidal patients, the authors developed a computer program, a methematical prediction model, and a 'subjective' data base; computer interviews were then administered to 22 patients. The authors obtained a summary of the clinical state of each patient as well as a prediction of whether he would make a suicide attempt or not. They found that the patients preferred the computer interview to talking to a physician. In a separate retrospective study, the computer was more accurate than clinicians in predicting suicide attempts.
The greatest obstacle currently slowing the progress of research in computer-mediated psychotherapy is the fact that unless the physicians using it truly believe in its effectiveness, even the most sophisticated computer technology will fail. The more complex the tasks, the less likely are people, including mental health professionals, willing to believe that computers can successfully carry them out. Many people fear the psychotherapy experience would be dehumanized by the introduction of computer technology. But the medium must not be confused with the message; the computer is simply an extension of the therapist, permitting one therapist to treat not just a few, but thousands of desperate patients. The current state of computer-mediated psychotherapy is such that this medium appears to be best suited to individual psychotherapy of a brief or focused nature, particularly the cognitive-behavioral therapies. The introduction of computer technology into psychotherapy offers the significant advantages of flexibility, consistency, and economy that would make psychotherapy more effective and more readily available to a much broader patient population than the one presently benefiting from such treatment. The preceding discussion has been an attempt to offer some practical guidelines for patient selection for computer-mediated psychotherapy based upon available investigations. As such, it is nevertheless incomplete and open to future revision. Considerable work remains to be done before definitive recommendations can be made, but it is hoped that these suggestions may prove helpful to clinicians working at the frontier of this new and exciting therapeutic medium.
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