Systems of Psychotherapy: A Transtheoretical Analysis

1. Systems of Psychotherapy:A Transtheoretical Analysis Chapter 18. The Future of Psychotherapy

2. A Delphi Poll • Sensitive forecasting method named after the famous Greek oracle • Structures group communication so that expert panel reaches consensus on complex problems • Panel predicted the future of psychotherapy over next 10 years • 73 distinguished clinicians completed 2 polling phases

3. Predicted Theoretical Orientations of the Future I What’s Hot(mean rating of 4.8 & higher) • Mindfulness therapies • Cognitive-behavior therapy • Integrative therapy • Multicultural • Motivational interviewing • Dialectical behavior therapy • Eclectic therapy • Exposure therapies • Interpersonal therapy

4. Predicted Theoretical Orientations of the Future II What’s Mild(mean rating of 3.6 - 4.7) • Cognitive therapy • Acceptance & Commitment therapy • Systems/family systems therapy • Attachment-based therapies • Behavior therapy • Relational therapy • Experiential therapies • Narrative therapy • Solution-focused therapy • Psychodynamic therapy

5. Predicted Theoretical Orientations of the Future III What’s Not Hot(mean rating of 3.59 & lower) • Person-centered therapy • Humanistic therapy • Feminist therapy • Male-sensitive therapy • Existential therapy • EMDR • Gestalt therapy • Reality therapy • Psychoanalysis (classical) • Jungian • Adlerian • Transactional analysis

6. Therapy Methods of Future Methods predicted to increase: • Computer technology (smartphone apps, social networking interventions) • Client self-change (self-help, self-control procedures, bibliotherapy) • Skill-building methods (homework, problem solving, cognitive restructuring) • Interpersonal support (fostering the alliance, providing support, expressing warmth)

7. Treatment Formats of Future • Increasing: short-term therapy, very brief therapy, psychoeducational groups, crisis intervention, population-level interventions • Remain same: Couple/marital, group, individual, conjoint family therapies • Decreasing: long-term therapy

8. Emerging Directions • Economics of Mental Health Care • Restricting access to mental health treatment • Limiting amount of psychotherapy • Using lowest cost providers • Implementing utilization review • Reimbursing only short-term therapy • Shifting to outpatient care • Requiring referrals through gatekeepers • Restricting patient’s freedom in therapists • Denying reimbursement for certain problems

9. Emerging Directions 2. Evidence-Based Practice (EBP) • Integration of best research evidence with clinical expertise & patient culture, preferences, and characteristics • Aim: improve effectiveness & enhance public health • What is designated as EBP will increasingly determine what therapies are reimbursed, taught, funded, and promoted • Research evidence of effectiveness will be required: treatment guidelines & outcome monitoring

10. Evidence-Based Practices

11. Emerging Directions 3. Therapy Relationship • Virtual unanimity that it is central to outcome • Emergence of evidence-based relationships; science tells what works relationally as well as technically • Graduate training and treatment manuals will increasingly attend to therapy relationship

12. Emerging Directions 4. Technological Applications • Computers, behavioral e-health, virtual reality, telehealth, mHealth • Clinicians can conduct psychotherapy around the world at any hour of the day • Psychotherapy of the future may only require one person and a computer • Sensor technology provides info about patient (e.g., heart rate, mental state)

13. Emerging Directions 5. Self-Help Resources • Self-help books, Internet sites, films, clients’ autobiographies, self-help & 12-step groups • Mental health professionals will increasingly recommend “do-it-yourself” therapies • Self-help is the country’s de facto treatment for most behavioral disorders

14. Emerging Directions 6. Neuroscience • Psychotherapy becoming “brain therapy” • Requires a new way of thinking about & talking about how psychotherapy works • We will treat brain illnesses based on molecular biology • May enhance prevention by identifying biological indicators of vulnerability

15. Emerging Directions 7. Personalized Psychotherapy • Tx increasingly tailored to patients’ transdiagnostic characteristics, such as stage of change, resistance level, and culture • Client preferences are frequently direct indicators of best therapy method • Clinicians will adapt treatment to patient’s religion or spirituality (religious-accommodative therapies)

16. Emerging Directions 8. Well-Being • Identifying patients’ character strengths and virtues • Building strengths rather than focusing solely on problems • Helping organizations & communities develop resilience, justice & optimism • Simultaneously treat psychopathology and promote well-being

17. Emerging Directions 9. Combined Psychotherapy & Pharmacotherapy • The use of psychotropic medications has risen dramatically • Combined treatment: becoming the rule, rather than the exception • Combined therapy raises questions and requires decisions on complex care

18. Emerging Directions 10. Integrative Behavioral Health • Over 70% of health-care costs due to behaviors (e.g., smoking, alcohol, obesity, pain, stress) • Movement toward integrated primary care; collaboration with other health-care professionals • Co-action: changing multiple behaviors simultaneously • Therapists will routinely treat the behavioral side of health problems & chronic illnesses

19. Emerging Directions 11. Proactive Treatment of Populations • Proactive outreach will increase % of high-risk people receiving treatment • Target the entire population, not only individuals in action stage • Many in the population are in contemplation or precontemplation

20. Emerging Directions 12. Psychotherapy Works • Therapy has meaningful, positive effects on intended outcomes across settings • Average effect size = .80 (large effect); average treated client is better than 79% of untreated clients • Typical magnitude of psychotherapy rivals & exceeds that of “medical breakthroughs” • Effect sizes translate into happier & healthier people! • Practitioners, patients, policymakers, and payers will increasingly recognize science supporting effectiveness

21. Key Terms behavioral e-health behavioral health care coaction combined treatment Delphi poll empirically supported treatments evidence-based practice (EBP) evidence-based relationships executive coaching industrialization of mental health care integratedprimary care mhealth neuroscience outcome monitoring personalizedpsychotherapy population-based interventions positive psychology practice guidelines proactive outreach religious-accommodative therapies self-help telehealth treatment adaptations

22. Recommended Websites • Cochrane Collaboration: www.cochrane.org/ • Evidence-Based Behavioral Practice: www.ebbp.org • International Society for Research on Internet Interventionswww.isrii.org/ • National Guideline Clearinghouse: www.guideline.gov/ • Society for Neuroscience: www.sfn.org/ • Society of Behavioral Medicine: www.sbm.org/