Chapter 11 -- General Issues in Psychotherapy

I. Level of Psychotherapy Effectiveness
A. Meta-Analyses of Efficacy Studies (in the lab)
1. Large effect sizes of .85 standard deviation improvement, better than most medical treatments
2. Show the average treated person is better off than 80% of untreated people
B. Effectiveness Studies (outside the lab)
1. Cognitive and behavioral approaches have largest effects
2. People benefit from most therapy
3. Debate over developing skills vs. relationship with therapist

II. Effectiveness of Therapies by Disorders
A. Cognitive-behavioral therapies are superior for most disorders
B. Interpersonal therapy is comparable for depression and eating disorders
C. Dialectical behavior therapy for borderline personality disorder
D. Community reinforcement and social skills training for alcoholism
E. Family intervention, social skills training, and supported employment for schizophrenia

III. Common Factors of Effective Therapy
A. Support (therapeutic alliance)
B. Learning (gaining insight)
C. Action (regulating behavior)
D. Hope (positive expectations)
E. Attention (improvement when observed)

IV. Predictors of Effectiveness
A. Therapist factors
1. General relational skills help
2. Skillful selection and application of techniques help
3. Distressed therapists hurt client outcomes
B. Client factors
1. Young substance abusers have poor outcomes
2. More severity related to poorer outcomes
C. Treatment factors
1. More improvement with high social support and less functional impairment
2. Moderate stress is better than low or high stress
3. Trusting relationship helps
4. Exposure to targets of behavioral and emotional avoidance helps
5. Focus on skills and reducing symptoms helps externalizing problems and relationship focus helps internalizing problems
6. Directive interventions for the non-resistant and prescribe the symptomatic behavior for the resistant clients

V. Theoretical Orientations Used
A. Cognitive is largest (31%), grown fastest in past 50 years
B. Eclectic/Integrative (22%), decreased in past 40 years
C. Psychodynamic (18%), decreased also
D. Behavioral (15%), increased over time
E. Humanistic (2%), decreased over time