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known for factor analysis; wrote 1952 article on psychotherapy outcome in which he found that 72% of untreated neurotic individuals improved without therapy, while 66^ of patients receiving eclectic psychotherapy and 44% receiving psychoanalytic psychotherapy showed a substantial decrease in symptoms; concluded that any apparent benefit of therapy is due to spontaneous remission



used to combine the results of multiple studies and involves calculating an effect size


Effect size

converts the data from different studies to a common metric so that results can be quantitatively combined and compared

calculation of an effect size usually involves subtracting the mean outcome score of the control (or other comparison) group from the mean outcome score of the treatment group and dividing the difference by the standard deviation of the control group


Smith, Glass, & Miller (1980)

used meta-analysis to combine the results of 475 outcome studies published between 1941 and 1976 and obtained a mean effect size of .85; which indicates that, at the end of therapy, the average therapy client is better off than 80% of those who need therapy but remain untreated


Lipsey & Wilson (1993)

conclude that effect size estimates for psychological treatments equal or exceed those for medical and educational interventions and are sufficiently large to support the claim that psychological treatments are generally efficacious in practical as well as statistical terms


Lambert & Bergin (1994)

positive change in therapy is not due to any unique or specific techniques but, instead, to factors that the various treatments share in common (e.g. catharsis, therapeutic alliance, behavioral regulation, and cognitive learning/mastery)


Howard and his colleagues (1996)

indicates that the relationship between treatment length and outcome "levels off" as about 26 sessions; referred to as dose-dependent effect


Howard et al. phase model

predicts that the benefits of treatment vary, depending on number of sessions; effects of therapy can be described in terms of three stages that are related to the length of treatment:
- remoralization- a client's feelings of hopelessness and desperation respond quickly to therapy
- remediation- focus is on the symptoms that brought client to therapy; symptompatic relief usually requires about 16 sessions
- rehabilitation- focuses on "unlearning troublesome, maladaptive, habitual behaviors and establishing new ways of dealing with various aspects of life


Efficacy vs. effectiveness research

efficacy studies- clinical trials
effectiveness studies- correlational or quasi-experimental in nature

- strict experimental control required by efficacy studies limits the generalizability of their results

- efficacy studies are most useful for establishing whether or not a treatment has an effect, while effectiveness studies are best for assessing clinical utility (generalizability, feasibility, and cost-effectiveness


Sue (1991)

Clients from all groups were likely to show improvement in Global Assessment Scale but that Hispanic American clients had the best outcomes followed, in order, by Anglo, Asian, and African American clients


Utilization of Mental Health Services

the utilization rates of mental health services differ for different racial/ethic groups, type of treatment setting, and type of problem


Premature termination rates

overall, members of ethnic and cultrual minority groups are more likely than Whites to terminate therapy prematurely; 50% of racial/ethnic minority groups dropout after the first session compared to 30% of White clients; African Americans had a higher premature dropout rate than Whites, Asians had a lower rate; Hispanic had a rate similar to that of Whites


Therapist-client matching

- inconclusive results

- ethnic matching reduced premature termination rates for Asian, Hispanic, and White Americans but not for African Americans and that matching was associated with improved treatment outcomes for Hispanics only

- 2002 study concluded that ethnic matching has a small, but not significant, positive effect on number of therapy sessions attended


Most common mental health problems among older adults = APA 2002

anxiety, severe cognitive impairment, depression


Treatments for older adults

1. behavioral and environmental interventions have been well-established as effective approaches for older adults for behavior problems associated with dementia
2. memory and cognitive retraining have been found "probably efficacious" for patients with dementia
3. cognitive behavioral and brief psychodynamic therapies have been shown to be probably efficacious as treatments for depression


Victims of Spousal/Partner Abuse

Women are more likely to be victims when they are younger, heterosexual, American Indian/Alaskan native (followed by African American) and in families that have yearly incomes less than $10,000

Family income was the best single predictor of cessation of battering

Conjoint couples therapy may be helpful when abuse is expressive (primarily the expression of emotion, is mutual or reciprocal, and is followed by remorse), but contraindicated when abuse is instrumental (committed without provocation and to achieve a goal, is unilateral, and is not followed by remorse


Factors affecting the decision to remain in an abusive relationship

Woman's commitment to relationship-- the more emotionally attached to the batterer, are desirous of saving the relationship, or have been in the relationship for an extended period of time are more likely to stay

Other factors include economic dependence, a belief that the batterer will change, and fear that the batterer will retaliate against the woman and/or children if she leaves


Treatment Manuals

were originally developed to standardize psychotherapeutic treatments so their effects could be empirically evaluated and to provide guidelines for training therapists

cons- oversimplify therapeutic process and can lead to the misuse of therapeutic techniques

pros- help disseminate info about empirically validated treatments and capitalize on tan actuarial approach to clinical decision making and avoid pitfalls of clinical judgment


Placebo effect

participants in placebo conditions typically show greater improvement in symptoms than those in no-treatment or wait-list control groups

ongoing debate is whether or not placebo controls make sense in psychotherapy research. Critics argue that not useful and has not helped identify the "active ingredients" of psychotherapy


Diagnostic overshadowing

originally used to describe the tendency of health professionals to attribute all of a person's psychiatric symptoms to his or her intellectual disabilities. Subsequent research has shown that diagnostic overshadowing is not related to a professional's theoretical orientation, expertise, or experience and that it applies to other conditions, diagnoses, and situations


Vocational overshadowing

a professional overlooks a client's vocational problems because the client has a co-existing personal problem


Alloplastic intervention

goal is to make changes in the environment so that it better accommodates the individual


Autoplastic intervention

goals to change the individual so that he/she is better able to function effectively within his/her environment


Therapist Distress

74.3% of participants said they had experienced personal distress in past 3 years
36.7% saying it decreased the quality of their work
4.6 admitting it resulted in inadequate treatment


Therapist Work Related Problems

1. suicidal statements are most stressful type of client behavior
2. lack of therapeutic success most stressful aspect of work
3. issues related to confidentiality constitute the most frequently encountered ethical/legal dilemma


Psychiatric Hospitalization

mental illness is higher among females than males in each age group
however, admission rates to psychiatric hospitals have more men; men are more likely to act out and be considered threatening by society


Psychiatric Inpatients

Marital satus- admission rates into psychiatric hospitals are lowest among the widowed, intermediate for those who are married or divorced/separated, and highest for the never married

Race/ethnicity- although whites represent the largest number of psychiatric inpatients when population proportions are taken into account, patients from other races are overrepresented

Age- for both men and women, the largest proportion of admissions is in the 25 to 44 age range

Diagnosis- schizophrenia is the most common diagnosis for inpatients in the 18-44 range; for ages 65+, an organic disorder is the most common diagnosis followed by an affective disorder