Announcements

1. Studying Psychotherapy I(Chapter 10)PSYC 4500: Introduction to Clinical PsychologyBrett Deacon, Ph.D.October 22, 2013

2. Announcements • Exam #2 returned today • Midterm grades posted tomorrow • Next response paper is due this Thursday, October 24th • Following response paper due next Tuesday 10/30 • Following response paper due Tuesday, 12/4

3. Remaining Schedule • Science and psychotherapy (4 classes) • Psychodynamic psychotherapy • Client-centered psychotherapy • Cognitive-behavioral therapies (3 classes) • Eye movement desensitization and reprocessing • Meeting with Laura Delano • Exam #3 (date TBA)

4. Questions for Lilienfeld et al. (2013) article; Response paper due this Thursday 10/24 • Questions • List and describe what you believe to be the three most important sources of practitioner resistance toward science-based practice in psychology.

5. Questions for Baker et al. (2009) article; Response paper due next Tuesday 10/30 • 1. Beyond symptom reduction, what patient outcomes are particularly important to “decision makers” (e.g., insurance companies, government agencies) in evaluating a psychotherapy? • 2. Describe two key factors in medicine’s development from an art to a science in the early 1900s. • 3. What is your opinion of the new accreditation system proposed by the authors?

6. Psychotherapy Research • Can we study psychotherapy? • Is it important to study psychotherapy? • Is psychotherapy research relevant to clinicians in the real world?

7. Psychotherapy Research • Can we study psychotherapy? • What is required in order for a psychotherapy to be studied? • Specify patients, measures, technique • Plausible mechanism? • Is it possible to faithfully recreate the process of psychotherapy in a research context? • Problems with standardization (manualizing therapy, assessing outcomes, etc.)

8. Psychotherapy Research • Is it important to study psychotherapy? • Are all therapies equally effective? • The “Dodo Bird” verdict (from Alice in Wonderland: “everybody has won and all must have prizes”) • The Smith & Glass (1977) meta-analysis • Strupp & Hadley (1979) college professor study • Common factors across therapies

9. Common Factors in Psychotherapy • 1. Expectations of improvement • 2. Confronting/facing the problem • 3. Receiving a compelling rationale • 4. Participation in a treatment ritual • 5. Providing an experience of mastery over problem • 6. Attributing success to internal factors • 7. Therapeutic relationship • Also: regression to the mean, passage of time, spontaneous recovery

10. Arguments for the Dodo Bird verdict (Psychotherapy Equivalence) • Many “bona fide” therapies work equally well in clinical studies (as shown in meta-analyses) • Common factors are responsible for benefits of (any) psychotherapy • Strength of therapeutic alliance reliably predicts patient outcomes

11. Arguments Against the Dodo Bird verdict (Psychotherapy Equivalence) • Plenty of evidence for differential efficacy of psychotherapies for specific problems • Discussing psychotherapy equivalence in absence of context makes no sense • Treatments may be equally effective but work via different mechanisms • Mean correlation between therapeutic alliance and outcome = .22 (DeRubeis et al., 2005) • Directionality of this relationship? • Why do self-administered treatments work?

12. Common Factors in Psychotherapy • Given the power of these common factors, what should we conclude about treatments that perform no better, or worse, than no treatment in controlled studies?

13. A Critical Thinking Exercise: Analyzing a Fake Journal Article Abstract Comparative Efficacy of Surgery and Medication: A Meta-Analysis The authors report a meta-analysis of clinical studies published from 1950-2010 on the efficacy of drug and surgical techniques for all medical problems. High-quality randomized controlled trials were selected that compared either medication or surgery to a control condition. The results suggest that each treatment modality is effective. The mean effect size produced by surgical treatments when results were combined across 3,765 studies of 3,765,987 patients with various medical conditions was d = .82. The mean effect size produced by drug treatments across 5,376 studies of 8,457,876 patients with various medical conditions was d = .84. The difference between these effect sizes was not statistically significant. Drug and surgical treatments yield highly comparable benefits, and patients seeking treatment for medical problems are likely to benefit equally from these approaches. The equivalent efficacy of these modalities suggests that they work through the same underlying non-specific mechanisms, such as the presence of an empathic helper and a strong therapeutic relationship. On the basis of the present findings, professional efforts to identify and disseminate specific evidence-based practices for specific medical problems are misguided. Patients should be encouraged to select either treatment for any medical problem in accordance with their personal preferences.

14. From Last Class • Can we study psychotherapy? • Is it important to study psychotherapy? • Is psychotherapy research relevant to clinicians in the real world?

15. Psychotherapy Research • Why should you care about psychotherapy research? Why is this topic important?

16. Psychotherapy Research • Is psychotherapy research relevant to clinicians in the real world? • Objections to clinical trials: • Nature of patients • Nature of therapists • Nature of the therapy