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Psychotherapy outcome research.
Abstract
focuses on the implications of psychotherapy research for the practice of eclectic psychotherapy / first, several controversial issues, such as the general effects of therapy, are addressed / then the factors that have been identified as causing therapeutic improvement are discussed / finally, directions for future research are suggested (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... Providing support throughout the program completion process has been shown to improve adherence and treatment outcomes. A body of studies has supported the significance of 'shared variables,' such as the working alliance, in achieving beneficial treatment results in traditional face-to-face therapy [37]. Treatment support has also been found to be a moderating element impacting therapeutic results and engagement [23]. ...
Despite being commonly perceived as healthy, approximately 20% of adolescents experience depression. To address this issue, computerized cognitive behavioral therapy (cCBT) has emerged as a potential solution. While cCBT has demonstrated effectiveness in treating depression among adults, its efficacy for adolescents lacks substantial evidence due to challenges in engaging them with the therapy. Thus, this study aims to identify the specific requirements essential for implementing cCBT with adolescents. By conducting semi-structured interviews with five patients, this research not only confirms existing findings but also unveils unique perspectives from the adolescents. Seven factors have been identified which are aesthetic, interactivity, accessibility, therapeutic alliance, exposure, audio, and personalization. The study findings contribute to a deeper understanding of implementing cCBT for depressed adolescents, informing future interventions and therapeutic approaches.
... The present study's findings linking the MI spirit to client agency are also notable given that agency is thought to be associated with better psychological functioning through self-directed client activities, both in and outside of therapy sessions (Williams & Levitt, 2007). In fact, past research has shown that such client activities are associated with better treatment outcomes and account for more outcome variance than specific therapy tasks associated with a particular model (Lambert, 1992;Ogles, Anderson, & Lunnen, 1999). Such findings may also help explain the findings of the larger trial which found that the MI-CBT group demonstrated continued improvement to one-year follow-up after the end of treatment (Westra et al., 2016), and that this longterm effect was mediated by less midtreatment resistance (presumably as a function of MI privileging and respecting client autonomy-taking and agency during moments of doubt in the treatment or therapist; Constantino, . ...
Objective:
Addressing methodological shortcomings of prior work on process expectations, this study examined client process expectations both prospectively and retrospectively following treatment. Differences between clients receiving cognitive behavioral therapy (CBT) versus motivational interviewing integrated with CBT (MI-CBT) were also examined.
Method:
Grounded theory analysis was used to study narratives of 10 participants (N = 5 CBT, 5 MI-CBT) who completed treatment for severe generalized anxiety disorder as part of a larger randomized controlled trial.
Results:
Clients in both groups reported and elaborated expectancy disconfirmations more than expectancy confirmations. Compared to CBT clients, MI-CBT clients reported experiencing greater agency in the treatment process than expected (e.g., that they did most of the work) and that therapy provided a corrective experience. Despite nearly all clients achieving recovery status, CBT clients described therapy as not working in some ways (i.e., tasks did not fit, lack of improvement) and that they overcame initial skepticism regarding treatment.
Conclusions:
Largely converging with MI theory, findings highlight the role of key therapist behaviors (e.g., encouraging client autonomy, validating) in facilitating client experiences of the self as an agentic individual who is actively engaged in the therapy process and capable of effecting change.
... This then enables the common boundaries to be understood and shared. Following Lambert (1992), there are non-specific factors, which result in client improvement regardless of specific expertise or practice, which result in client satisfaction, and can be attributed to: client and extra-therapeutic factors (40%) (such as ego strength, social support, etc.); the therapeutic relationship (30%) (such as empathy, warmth, and encouragement of risk-taking); as well as expectancy and placebo effects (15%), while the skilled abilities, in the form of specific techniques (such as art therapy), are emphasized as being the conduit to understanding the client's world. One of the main theories of knowledge used to explain the knowledge acquired in art therapy sessions is referred to as the expressive Therapies Continuum (eTC; Lusebrink, 2016). ...
This critical inquiry explored external perceptions of art therapy. By focusing on the organizational contexts and structures that art therapy practices are typically situated within, the purpose of the study was to understand: How the values that art therapists intrinsically hold within practice transmitted, translated, and interpreted by other mental health professionals. To gain rich and detailed views, nine mental health professionals were interviewed. Through analysis of the findings, a critically reflexive form of practice was developed to assist art therapists in substantiating their role, while strengthening a team mentality to provide better services to their clients. Study implications involve the need to further explore how art therapists can develop professionally, as well as expand on strategies for how art therapy can be further valued within mental health systems.
Tympanoplasty is an operation on the tympanic membrane and in the middle ear. By removing
the diseased tissue, restoring the ossicles and closing the tympanic membrane perforation it is
aimed at establishing a functioning middle ear that ensures good transmission and adequate
amplification of sound. Here we describe the historical development of tympanoplasty, its
surgical technique and classifications and categorizations of tympanoplasties.
Τhis study aimed to examine the evolution of the therapeutic relationship in systemic therapy through the theoretical developments of systemic thinking over the last few decades. In the first part, a historical overview of the de-personalized therapeutic relationship according to First Order Cybernetics perspective (from ‘50s to ‘70s) is presented, that proceeds to the therapeutic relationship with emotional disclosure in the 80s (Second Order Cybernetics) and the Constructivist position that allowed an engagement in an ongoing relational process in therapy. Further, it traces the modifications of the therapeutic relationship through the post-modern developments; Social Constructionism, Reflexivity and Narrative therapy that allow therapist’s essential emotional involvement during co-construction of the meaning in psychotherapy, presents in brief the "revolutionary" view of the theorist of the Open Dialogue (Seikkula, 2011), the Attachment Theory meta-model and the importance of secure attachment in therapeutic relationship. Throughout this review the issue of power imbalance in the therapeutic relationship is discussed, as this underlies the ideological debate of client’s resistance towards the therapist’s positions. In the second part, methodological approaches and psychometric tools regarding research for the documentation of the importance of the therapeutic relationship in systemic therapy are reviewed and research findings are presented concerning the prevailing factors in the therapeutic relationship from the client’s point of view. Finally, issues for further training and enhanced competence of the therapist in order to response effectively to current social-cultural needs are highlighted.
Imagine that cognitive therapy only indirectly contributes to the success of therapy. That is, consider the client as architect of change and cognitive therapy as merely a collection of blueprints, tools, and resources at the disposal of the client. If we remove ourselves as therapists, theoreticians, and researchers from center stage and place the spotlight on the client, how does this change our view of the work we do? What new questions can we ask? What different answers emerge?
This study tested emotion-focused therapy (EFT) theory assumptions concerning optimal emotion schematic processing during experiential psychotherapies. Emotion schematic change was investigated in the particular problem context of resolving self-criticism, an emotion schematic vulnerability to depression identified across all major psychotherapy theories.
The sample was nine highly self-critical depressed clients who received experiential treatment (n = 5 resolved while n = 4 did not resolve their self-criticism by termination). Emotion episodes (EEs) were exhaustively sampled from five sessions across three therapy phases (early, working phase, and termination) for each client. All their EEs across therapy were coded using a process measure called the Classification of Affective-Meaning States. Three complementary analytic procedures were used to examine emotion schematic changes within and across phases of therapy: graphical/descriptive, linear mixed modelling, and THEME sequential pattern analysis.
Convergent evidence from these analyses supported EFT theory. Good resolvers of self-criticism decreased expression of secondary emotions and increased expression of primary adaptive emotions. Good resolvers also exhibited more sequences of EEs consistent with transformation of secondary and maladaptive emotions to adaptive emotions. Future directions of this research are discussed.
Accountability via the application of research to practice is the raison d'être of the empirically supported treatment (EST), evidence-based treatment (EBT), and evidence-based practice (EBP) movements. Although basing practice on empirical findings seems only reasonable, application becomes complex when unfurled in the various social, political, economic, and other ideological contexts that influence the delivery of mental health services (Norcross, Beutler, & Levant, 2006). This chapter describes two different approaches to defining and disseminating evidence (Littell, 2010)—one that seeks to improve clinical practice via the dissemination of treatments meeting a minimum standard of empirical support (EBT) and another that describes a process of research application to practice that includes clinical judgment and client preferences (EBP). We unfold the controversy by addressing the nature of evidence, how it is transported to real-world settings, and ultimately, whether such evidence improves client outcomes. To further inform the debate surrounding the two approaches, this chapter also discusses the randomized clinical trial (RCT), its specificity assumption, and the connection of the RCT to a medical model way of understanding psychotherapy. Finally, we strike at the heart of the controversy by tackling the thorny question of whether EBTs should be mandated.Keywords:evidence-based treatments;evidence-based practice;dodo verdict;common factors
Peut-on utiliser des techniques et etre centre sur la personne ? Pour moi, la reponse est « oui, mais… ». La theorie milite contre l’utilisation de techniques. Les techniques sont en general centrees sur le probleme et dirigees par le therapeute plutot que dirigees par la personne et centrees sur la confiance. D’une maniere ou d’une autre, elles portent habituellement l’empreinte de l’expertise du therapeute. A moins qu’elles n’emergent de la rencontre du therapeute et du client, les techniques eloignent l’attention du therapeute du monde du client. La premiere raison d’introduction de techniques dans le cadre de reference centre sur le client est d’aider le therapeute a se liberer de ses barrieres pour s’impregner du monde perceptuel du client. Ainsi peut se concretiser la puissance remarquable de la confiance dans le propre chemin du client, sa propre direction, son propre rythme. Je suis personnellement d’accord avec Rogers lorsqu’il dit : « si je pensais que je savais ce qu’il y a de mieux pour le client, je le lui dirais ». De meme si je pensais que je savais qu’une technique particuliere etait meilleure pour un client, je l’utiliserais. Cependant, je ne peux imaginer que cela arrive.
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