Psychotherapy Outcome Research Research Articles

Psychotherapy Research, the Recovery Movement and Practice-Based Evidence in Psychiatric Rehabilitation

This article reviews the literature on psychotherapy outcome research and discusses the relationship between those findings and the tenets of the consumer-driven recovery model. The research provides compelling evidence for practitioners to abandon the current emphasis on diagnosis and theory, model, and technique in favor of a partnership with clients that leverages the common factors and places emphasis on the alliance. Empirical support of the shortcomings of evidence-based practices is provided. Use of outcome and alliance feedback to inform the work and shift to practice-based evidence is offered as a practice that is informed by the research and honors the recovery model's call for consumer-driven mental health services.

Clinically significant change in psychotherapy for depressive disorders

BackgroundThe assessment of change has been a problematic issue in psychotherapy research and has become increasingly important in the up rise of evidence-based practices. MethodsIn the present paper, the clinical significance of the change of 243 patients who received one of nine treatments for depression was analysed using the Reliable Change Index [Jacobson, N.S., Follette, W.C., Revenstorf, D., 1984. Psychotherapy outcome research: Methods for reporting variability and evaluating clinical significance. Behav. Ther. 15, 336–352.] and normative comparisons (Equivalency Testing; [Kendall, P.C., Marrs-Garcia, A., Nath, S.R., Sheldrick, R.C., 1999. Normative comparisons for the evaluation of clinical significance. J. Consult. Clin. Psychol. 67, 285–299.]). While the first method addresses the question of whether or not the change that occurred was large enough to be attributable to treatment rather than to measurement error, the second method addresses the issue of comparing the level of functioning of treated individuals with non-clinical population. Hence, the nine treatments of depression were compared in terms of their reliability and clinical significance. Traditional statistical tests in treatment outcome studies were also conducted. ResultsFindings support the importance of analysing the clinical significance of change during psychotherapy. While all but one treatment led to statistical significant changes in depressive symptoms, differences among treatments were found in terms of their reliability and clinical significance. LimitationsSmall sample sizes and representativeness of each treatment warrant further replication of these results. ConclusionsImplications of the use of clinical significance testing in the exploration of empirical support for psychotherapy treatments in conjunction with traditional statistical analyses are discussed, which will be more readily useful and meaningful to clinicians who wish to embark in evidence-based practices.

Investigação em psicoterapia com crianças: uma revisão

O objetivo deste estudo foi realizar uma revisão bibliográfica sobre as pesquisas mais recentes em psicoterapia com crianças, com ênfase na psicoterapia psicanalítica infantil. Procedeu-se à revisão de todos os trabalhos encontrados na consulta às publicações científicas indexadas de acesso on-line e aos livros-textos das áreas de avaliação de resultados de psicoterapia psicanalítica com crianças, avaliando e discutindo os aspectos metodológicos. Os resultados demonstraram que, apesar dos avanços alcançados, ainda existe uma escassez de pesquisas na área, principalmente no que diz respeito às pesquisas que comprovem a efetividade das psicoterapias de orientação psicanalítica com crianças. Por último, conclui-se que existe uma necessidade de desenvolver estudos com metodologias mais sofisticadas para avaliar os resultados de psicoterapia com crianças.

Review of Psychodynamic diagnostics manual (PDM).

Reviews the book, Psychodynamic diagnostics manual (PDM) by Alliance of Psychoanalytic Organizations (2006). This volume is divided into three major sections, Part 1--Classification of Adult Mental Heath Disorder, Part 2--Classification of Child and Adolescent Mental Health Disorder, and Part 3--Conceptual and Research Foundations for a Psychodynamically Based Classification System for Mental Health Disorders. Unlike the standard DSM which highlights the patient's presenting symptom (Axis I) with secondary consideration given to an underlying personality disorder (Axis II), the major thesis of classification scheme of this volume is that diagnostic evaluation should provide a more patient centered and a more clinically useful picture of the individual by understanding the symptom(s) through the essential dimensions of the patient's personality and mental functions (interpersonal and cognitive capacities). Part 3, which could stand on its own as a separate volume, is a thorough critique of psychotherapy outcome research in which the authors delineate how major design flaws have derived from "favoring what is measurable over what is meaningful." The authors cogently demonstrate that diagnostic assessment is a continuous effort toward providing individualized and clinically relevant evaluations. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The rocks and hard places in psychotherapy outcome research

The field of traumatic stress has experienced significant growth in the number of psychotherapy treatment studies conducted, especially in the past 10 years. In this article, the author aims to help both the readers of this work and psychotherapy researchers by reviewing key concepts in trial design and discussing issues unique to psychotherapy (and other nonpharmacological interventions). The discussion is broad and nontechnical, particularly with respect to statistical issues. The focus is on between-group randomized designs, and on outcome rather than process. Examples are drawn from posttraumatic stress disorder treatment studies to enhance relevance to the field of traumatic stress.

Can research influence clinical practice?

After briefly reviewing the unfavourable reception accorded empirical research by parts of the psychoanalytic community, as well as some of the benefits to clinical practice of analysts being involved in research activities, the author examines whether the findings of process and outcome research in psychotherapy and psychoanalysis can help identify the most appropriate forms of intervention for producing therapeutic change, given the specific condition of the patient and the relationship that the individual establishes with the analyst. He argues that research findings can influence clinical practice on various levels and in different areas, and goes on to examine a number of related issues: the specificity of therapeutic interventions versus the relevance of common curative factors; the dyadic conception of technique and ways of understanding the therapeutic action of the treatment alliance; and the strategic or heuristic conception in psychoanalytic therapy. Finally, the author presents clinical material with the aim of illustrating how the knowledge acquired through research can be applied to psychoanalytic treatment.

Measuring Transference Phenomena With fMri

Measuring Transference Phenomena With fMri

Psychodynamic Therapy for Oppositional Defiant Disorder: Changes in Personality, Object Relations, and Adaptive Function After Six Months of Treatment

Michael Bambery (University of Detroit Mercy) and John H. Porcerelli (Wayne State University School of Medicine)Bridging the gap in youth psychotherapy outcome research betweenresearch findings stemming primarily from the tightly controlledresearch laboratory and the “real world” clinical setting has been thevirtuous and necessary focus of many mental health researchers and clin-icians (Weisz, Doss, and Hawley 2005; Westen, Novotny, and Thompson-Brenner 2004). A criticism of many laboratory-based studies is that theydo not reflect actual clinical practice. Weisz, Doss, and Hawley (2005)reported in their methodological analysis of youth psychotherapy out-come research from 1963 through 2002 that across disorders 13% ofstudy sample participants had sought treatment or were self-referred,Downloaded from apa.sagepub.com

CHANGE NORMS: A COMPLEMENTARY APPROACH TO THE ISSUE OF CONTROL GROUPS IN PSYCHOTHERAPY OUTCOME RESEARCH

Abstract Control groups are widely regarded as a sine qua non of psychotherapy outcome research. However, they produce high costs and are not applicable to long-term studies. The authors address the issue of control groups in psychotherapy research in a novel way: They systematically study the changes occurring in psychiatric patients who did not receive any specific treatment. Such data may serve as reference data for further outcome studies. It would then no longer be necessary to collect reference data repeatedly in each and every new study. The authors evaluated the changes that occurred in the control groups of available randomized controlled studies (RCTs) of psychodynamic psychotherapy in a first and preliminary trial. Twenty-six RCTs of psychodynamic psychotherapy, in which reliable and valid outcome measures were applied and which provided the necessary data to calculate effect sizes, were included in a meta-analysis. Effect sizes were calculated for the mean changes occurring in the control grou...

Cognitive-Behavioral Therapy and Psychodynamic Psychotherapy: Techniques, Efficacy, and Indications

In this article, we provide an overview of the techniques and efficacy of the two most commonly used psychotherapeutic treatments of psychiatric disorders in adults: cognitive-behavioral and psychodynamic therapy. Psychotherapeutic techniques, major indications, and empirical evidence will be presented. The focus will be on empirically supported models of treatment. Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice. To give an up-to-date description of cognitive-behavioral therapy and psychodynamic psychotherapy and to review empirical evidence for efficacy in specific mental disorders. Systematic reviews of psychotherapy outcome research based on evidence-based methods were used. In order to identify more recent trials, Medline, Psyclnfo, Pubmed, and Current Contents were searched in addition in July 2005 using database-specific keywords. In October 2005, the search was updated. Text books and journal articles were used as well. The authors reviewed the available systematic surveys and meta-analyses as well as the additionally identified studies using established inclusion criteria. Following the evidence-based methods of the Canadian Task Force on Preventive Health Care, an established hierarchy of study designs was applied. Using rigorous criteria, only evidence from randomized controlled trials (Type 1 studies) was included. The authors independently assessed for which mental disorders randomized controlled trials provide evidence for the efficacy of cognitive-behavioral therapy or psychodynamic psychotherapy in specific disorders. The efficacy of cognitive-behavioral in many mental disorders has been demonstrated by a substantial number of randomized controlled trials and several meta-analyses. However, for specific disorders the rates of treatment responders are not yet sufficient. For psychodynamic psychotherapy, clearly less efficacy studies are available. However, the available studies provided evidence that psychodynamic psychotherapy is an effective treatment of specific mental disorders as well. Although there is substantial evidence for the efficacy of cognitive-behavioral therapy and some evidence for the efficacy of psychodynamic psychotherapy, further studies are required to improve the positive outcome rates of treatment responders in specific mental disorders. For psychodynamic psychotherapy further studies of specific forms of treatment in specific mental disorders are required to corroborate the available results.

Randomized Clinical Trials in Psychotherapy Outcome Research

This paper discusses several philosophical problems with the use of randomized clinical trials (RCTs) in psychotherapy outcome research. The problems include: the impermanence problem, the identification problem, and idiographic problems. The paper concludes with an assessment of the overall case for and against the use of RCTs in psychotherapy outcome research.

Does Psychotherapy Help Some Students? An Overview of Psychotherapy Outcome Research

This article provides a brief overview of the outcome research on psychotherapy with children and adolescents. Outcome research indicates that psychotherapy can be effective with both children and adolescents, with meta-analyses indicating that youth who participated in this type of intervention tended to score on the outcome measures half of a standard deviation or more above those who did not receive any intervention. Little is known about the process of psychotherapy with children, but there are some indications that the therapeutic relationship is important. Moreover, there is some research that supports the assumption that certain types of treatment are most helpful with specific clinical issues.

The Role of Adult Attachment Styles in Psychopathology and Psychotherapy Outcomes

Attachment theory provides a model for understanding how the attachment styles formed in infancy systematically affect subsequent psychological functioning across the life span. Attachment styles provide the cognitive schemas, or working models, through which individuals perceive and relate to their worlds. In turn, these schemas predispose the development of psychopathologies and influence outcomes when people undergo psychotherapy. After reviewing recent empirical findings, the authors conclude that an understanding of attachment theory facilitates the conceptualization of clients' problems and the selection of appropriate interventions. Accordingly, attachment styles should be assessed as a standard part of treatment planning. Furthermore, the authors propose that attachment styles should be assessed as individual difference variables in psychotherapy outcome research because adult attachment styles dictate how people perceive and respond to their environments and, therefore, how clients respond differentially to various treatments.

Does Psychotherapy Help Some Students? An Overview of Psychotherapy Outcome Research

This article provides a brief overview of the outcome research on psychotherapy with children and adolescents. Outcome research indicates that psychotherapy can be effective with both children and adolescents, with meta-analyses indicating that youth who participated in this type of intervention tended to score on the outcome measures half of a standard deviation or more above those who did not receive any intervention. Little is known about the process of psychotherapy with children, but there are some indications that the therapeutic relationship is important. Moreover, there is some research that supports the assumption that certain types of treatment are most helpful with specific clinical issues.

Empathy, Psychotherapy Integration, and Meditation: A Buddhist Contribution to the Common Factors Movement

Clinicians from several theoretical approaches have explored the common ground between Buddhism and Western psychotherapeutic models. In this article, the synthesis of Buddhism and psychotherapy is considered from the context of psychotherapy integration. Toward that end, the Buddhism and psychotherapy literature and the psychotherapy outcome research is reviewed with a focus on the findings of therapy equivalence and common factors among treatment approaches. Empathy and the relationship variables factor are discussed; it is argued that Buddhist meditation contains a dialectic between striving and self-acceptance. An essential aspect of meditation is seen as identical to an essential component in therapeutic personality change. It is argued that therapist empathy and meditation promote a self-directed empathy that enhances the interdependence, integration, and cohesion of self. Several approaches to the integration of psychotherapy and Buddhist meditation are compared to the views presented here, and recommendations are offered for the clinical application of meditation training.

Maximizing Treatment Effectiveness in Clinical Practice: An Outcome-Informed, Collaborative Approach

Clinicians need easy-to-use, practical, systematic methods of evaluating, informing, and reporting the effectiveness of treatment. Practicing clinicians no longer have to rely on the DSM for treating their clients, but by making use of both outcome and process measures they can create a more collaborative and effective therapy with their clients. The findings from over 40 years of psychotherapy outcome research literature emphasize the importance of common factors as the curative elements central to all forms of therapy regardless of theoretical orientation. Methods discussed here offer practitioners the means to identify which clients are responding to treatment and those for which treatment is not working so that adjustments can be made to the therapy. The goal is to decrease dropout rates, increase levels of customer satisfaction, and document and improve the overall effectiveness of treatment.

A Tale of Two Visions: Can a New View of Personality Help Integrate Psychology?

Personality psychology studies how psychological systems work together. Consequently, the field can act as a unifying resource for the broader discipline of psychology. Yet personality's current fieldwide organization promotes a fragmented view of the person, seen through such competing theories as the psychodynamic, trait, and humanistic. There exists an alternative--a systems framework for personality--that focuses on 4 topics: identifying personality, personality's parts, its organization, and its development. This new framework and its view of personality are described. The framework is applied to such issues as personality measurement, psychotherapy outcome research, and education. The new framework may better organize the field of personality and help with its mission of addressing how major psychological systems interrelate.

Youth Psychotherapy Outcome Research: A Review and Critique of the Evidence Base

Over the past four decades, researchers have produced extensive evidence on psychotherapy for youth mental health problems and disorders. The evidence often has been evaluated through narrative reviews and through meta-analyses assessing the magnitude of treatment effects, but methodological analysis addressing the character and quality of the evidence base itself is an important complement, needed to place treatment effects in perspective and to suggest directions for future research. We carried out such an analysis, focusing on all the methodologically acceptable published randomized trials our search identified involving treatment of anxiety, depression, ADHD and related conditions, and conduct-related problems and disorders. The 236 studies tested 383 treatments and included 427 treatment-control comparisons, spanning the years 1962 through 2002. The analysis revealed considerable breadth, diversity, and rigor in the measurement approaches used to assess participant characteristics and treatment outcomes. However, reporting on important sample characteristics (e.g., ethnicity) showed major gaps, and more than half the studies failed to use well-standardized procedures to ensure appropriate sample selection. Because sample sizes left most studies underpowered, and procedures to enhance treatment fidelity were generally weak, many of the treatments investigated may not have received fair tests. Studies were particularly weak in clinical representativeness of their samples, therapists, and settings, suggesting a need for increased emphasis on external validity in youth treatment research.

Psychological Treatment of Musical Performance Anxiety: Current Status and Future Directions.

A comprehensive review of research evaluating psychological treatments of musical performance anxiety is provided. Studies were evaluated against key methodological criteria for psychotherapy outcome research. Available literature points to the utility of exposure and cognitive therapies, although there is no clear-cut evidence suggesting the superiority of one approach or benefits of combining the two. Past research is characterized by recurring methodological limitations, particularly overreliance on self-report outcome measures. Future investigations should consider screening out individuals who do not evidence marked dysfunction and whose anxiety results from weak technical ability, as well as including treatment manuals, multiple therapists, multichannel outcome measures, and follow-up data. Clinicians working with musicians experiencing performance anxiety may wish to incorporate exposure and cognitive restructuring in treatment.

The dodo-bird debate, empirically supported relationships and functional analytic psychotherapy.

Abstract The dodo-bird verdict has haunted the literature on psychotherapy outcome since its early beginnings. It is based on the counter-intuitive finding that often highly diverging treatments do not differ much in effectiveness. There is evidence that much of the common effect of different treatments can be related to unspecific factors as opposed to treatment-specific techniques. The present paper offers a short behavior analytic reflection on contemporary directions concerning effective therapeutic relationships. It suggests that the idiographic vision inherent in functional analysis may point at an alternative avenue for psychotherapy outcome research that is entirely different from those on empirically supported treatments and empirically supported relationships, and that this third direction may shed more light on the question as to what determines therapeutic change. Key-words: Dodo-bird verdict; Empirically supported therapies; Therapeutic relationship; Functional Analytic Psychotherapy. ********** Since the advent of research on the effectiveness of specific treatments for specific disorders (Eysenck, 1952; Chambless, 1996) therapy advanced tremendously and it seems it will never be the same again. As a result of this work, the well-trained therapist of today, confronting a client with this or that particular disorder will be able to choose and implement the treatment-package that will most probably be helpful. The bottom line is that a treatment that has been shown most helpful in studies for clients with a specific problem and specific characteristics, will be the most indicated treatment for a client one will meet in one's office with that same problem and those same characteristics. Critics of this development have been prolific. It has been pointed out that technique-driven protocols cannot consider the complexity of the therapeutic process and that the ecologic validity of the controlled studies is weak because the therapy settings in clinical practice vary widely (Garfield, 1996; Goldfried & Wolfe, 1996; 1998; Bohart, 2000). The Dodo-Bird Verdict Metanalyses (e.g. Smith, Glass & Miller, 1980; Wampold, et al., 1997; Luborsky et al., 2002) tend to corroborate Rozenzweig's (1936) verdict that everybody has won and must have prizes, a line taken from the Dodo-bird in Lewis Caroll's Alice's Adventures in Wonderland. That very dissimilar interventions have similar effects diminished the seeming importance of specific techniques. The Dodo-bird verdict came to evoke in specialists at least three standard types of reaction. A first type consists in pointing out that the meta-analyses don't permit disqualifying the effects of techniques and that it is more ethical to use techniques that have empirical support than to speculate about unspecific variables. Continued controlled studies are necessary to show what variables or interactions contribute to therapeutic changes (Eysenck, 1994; Chambless, 2002). A second type of reaction points at unspecific variables as holding the major promise for explaining what makes therapy work (Bohart, 2000; Messer & Wampold, 2002). The therapeutic encounter in itself can have an important effect on the client and the therapist as a person makes a difference. Characteristics of the relationship compete with specific techniques as possible explanations of why therapies work. They are often common to many different treatments, and have enough empirical support to give them a place alongside specific techniques in models about the active ingredients of therapy. Efforts to identify core relationship variables have been examined by a task force of the American Psychological Association's division 29 and reviewed in a book organized by Norcross (2002). These empirically supported relationships are aspects of the way in which client and therapist interact, that research has been able to relate favorably to treatment outcome or process. …