Does psychotherapy work?

1
Does psychotherapy work?

• A review of the research

2
Treatment efficacy (does it work?)

• Historically, therapy efficacy was of little
  interest until the 1950's
• Freud rejected outcome research (problems too
  heterogeneous -- "apples vs. oranges")
• Freud and contemporaries relied on case-studies
  to illustrate techniques

3
Hans Eysencks 1952 bombshell

• Methodology
• Outcome data for over 7000 neurotic patients
• 5 sets of psychoanalytic groups and 14 eclectic
  groups
• Findings
• Spontaneous recovery rate 72
• Psychoanalytic recovery rate44
• Eclectic recovery rate 62
• But Eysenck's study met much criticism
• Apples and oranges
• No control groups
• Outcome criteria differences (when criteria
  restructured and data reanalyzed)
• Spontaneous remission 30
• Psychoanalytic 83 and eclectic 65

4
The ideal efficacy study(Seligman, 1995)

• random assignment of patients to treatment and
  control groups
• treatment group
• no-treatment controls
• placebo controls
• patients meet criteria for only one psychiatric
  diagnosis
• treatments are manualized and scripted, with
  videotaping of sessions used to monitor and
  eliminate any spontaneous divergence from the
  prescribed approach
• patients are seen for a fixed number of sessions
  (usually 6-12)
• outcome measures are unequivocal and quantifiable
• raters and diagnosticians are blind
  (unknowledgeable) as to which group the patient
  is in
• post-treatment assessment after a fixed period is
  in place

5
Smith Glass (1980)

• Methodology meta-analysis of  475 psychotherapy
  outcome studies
• Findings People in treatment function better
  than 80 of patients w/ no treatment (on waiting
  list)
• Conclusions There are negligible differences
  between different types of therapy

6
Seligmans 1995 Consumer Reports survey

• Methodology
• 180,000 readers received issue w/survey
• 7,000 filled out survey, of which 3,000 saw
  mental health professionals
• Respondents
• educated
• middle class
• 50 female
• median age46
• Three outcome measures
• Specific Improvement
• Satisfaction
• Global Improvement

7
Seligmans 1995 Consumer Reports survey

• Findings
• Psychotherapy resulted in improvement for
  majority (90) of respondents
• Psychiatrists, psychologists, and social workers
  all equally effective but better than marriage
  counselors (after controlling for severity and
  type of problem)

8
Consumer Reports Findings (cont.)

• Longer treatment (i.e., more sessions) was
  related to more improvement

9
Consumer Reports Findings (cont.)

• Limitations on insurance coverage was associated
  with less improvement

10
Consumer Reports Findings (cont.)

• People who reported feeling the worst prior to
  treatment, reported the most improvement
• No difference between different types of
  therapies
• No difference between psychotherapy alone and
  psychotherapy with meds
• Active shoppers and active clients did better

Conclusion Psychotherapy works!
11
Seligmans 1995 Consumer Reports survey A
critique

• Non-random, potentially biased sample
• Cognitive dissonance may lead to positive bias
• Improvement may be due to spontaneous remission
  or regression to the mean

12
10 major achievements of psychotherapy outcome
research (Lambert Bergin, 1992)

• Psychotherapy generally has positive effects
• Many therapies gt placebo
• Research now looks at specific types
• Behavior therapies effective for many disorders
• Cognitive therapy effective for depression
• Different types often equally effective
• Therapies have many factors in common
• Therapy may have negative effects ?
• Brief therapy works for many (50)
• Effects are relatively lasting