Are psychotherapeutic changes predictable? Comparison of a Chicago counseling center project with a Penn psychotherapy project.

Results of 2 large-scale studies predicting the outcomes of psychotherapy were similarly analyzed and compared. The level of prediction success in both projects was modest, at best accounting for 5–20% of the variance of outcome, i.e., within groups of patients who started psychotherapy, this kind of prediction could not be done well. However, for the modest level that could be predicted, particularly for the Rated Benefits score, the profile of variables showed similar levels of success between Penn and the Chicago psychotherapy projects. The most successful of these predictions were based on (a) the adequacy of personality functioning, (b) the match on marital status, and (c) the length of treatment. (17 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical search for psychotherapists' gender competence in psychotherapy.

Over the past half century, psychotherapy research has demonstrated that psychotherapy outcomes do not vary based on clients’ gender (Clarkin & Levy, 2004; Garfield, 1994; Wierzbicki & Pekarik, 1993). However, most studies assumed that all psychotherapists are equally competent to treat men and women, thus potentially missing essential information about variations in psychotherapy outcomes. In fact, there is a paucity of studies that have examined if psychotherapists’ gender competence truly exists. We propose that psychotherapists’ gender competence should be defined as the psychotherapist’s ability to achieve positive psychotherapy outcomes with either female or male clients. This study examined the relationship between clients’ gender and psychotherapy outcomes and if psychotherapists varied in their abilities to produce positive psychotherapy outcomes for female and male clients. The sample included 93 male and 229 female clients treated by 31 psychotherapists. Consistent with previous research, the results demonstrated that clients’ gender was not related to psychotherapy outcomes. However, compared to other psychotherapists, some psychotherapists were better at treating men, whereas others were better at treating women. The results of this study demonstrate that psychotherapists’ gender competence exists and relates directly to the psychotherapy outcomes (i.e., psychological well-being) of clients. Implications for psychotherapy practice, training, and research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological response styles and cardiovascular health: Confound or independent risk factor?

Using results from 2 large cardiovascular studies, the authors examined the utility of treating psychological response styles as confounds (e.g., factors undermining relationships with other self-report variables) versus distinct personality traits in the prediction of cardiovascular health. Study 1 consisted of a 3-year prospective study of ambulatory blood pressure levels in healthy adults (N?=?125). Study 2 comprised a 12-week drug treatment program for ischemic heart disease patients (N?=?95). Participants completed measures of psychological factors and self-deception and impression management in each study. Results consistently favored using response styles as direct predictors. Self-deception scores predicted elevated 3-year diastolic and systolic blood pressure changes in Study 1 and poorer treatment outcomes in Study 2. Statistically controlling for response style effects within the psychological factors generally did not improve predictions. These findings argue against the conceptualization of response styles as stylistic confounds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does youth psychotherapy improve academically related outcomes? A meta-analysis.

To better understand the impact of psychotherapy on youth academic performance, the authors located and examined 83 studies of youth psychotherapy that contained 102 treatment comparisons. Results revealed a d = 0.46 overall effect size, with a d = 0.50 effect size for mental health outcomes, and a d = 0.38 effect size for academically related outcomes. Academically related outcomes were further categorized into teacher-rated classroom behavior (d = 0.26), academic achievement (d = 0.36), environmentally related outcomes (d = 0.26), and self-reported academically related outcomes (d = 0.59). Each of these effect sizes differed significantly from zero, and the 4 academically related categories were homogeneous. Participant racial and ethnic diversity and age were explored as moderators. The results point to psychotherapy benefiting student academics, regardless of age. Ethnically diverse participant groups in the studies fared better academically than did nondiverse groups. Implications discussed include counseling psychologists maintaining a holistic view of youth and of working more closely with educators. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Managed care policies rely on inadequate science.

Examines whether there is empirical justification for cutting length of therapy and lowering the qualifications of mental health providers. Efficacy and effectiveness research exist to evaluate the outcomes of psychotherapy. Today, psychotherapy is threatened by managed care organizations' drawing inferences from efficacy studies about appropriate treatment to justify business practices. The authors re-emphasize lack of scientific foundation for managed care's policies of severely limiting the length of psychotherapy and systematically using less well trained providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implications of payment of fees for psychotherapy.

Considers the question of how the payment of fees by clients for psychotherapy and related psychological services influences therapeutic outcomes. Psychoanalytic theory and cognitive dissonance theory suggest that clients who pay for psychotherapy will benefit more than those who pay nothing. This question and related issues are discussed with reference to observations and experimental studies that have explored how fees influence psychotherapy. Presently, sufficient evidence does not exist either to support or refute most of the hypotheses that have been generated, including the one that clients who pay a fee benefit more than those who pay nothing. Explanations for this void in the research literature and suggestions for expanding the understanding of this domain are provided. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes

The use of writing, alone or in conjunction with traditional psychotherapy, has increased substantially in recent years. The most widespread use of writing has been for single-shot ad hoc purposes or to log behavior. The purpose of this review is to summarize a decade of research demonstrating the efficacy of writing about past traumatic experiences on mental and physical health outcomes. It is widely acknowledged in our culture that putting upsetting experiences into words can be healthy. Research from several domains indicates that talking with friends, confiding to a therapist, praying, and even writing about one's thoughts and feelings can be physically and mentally beneficial. This review highlights advances in written disclosure that determine some therapeutic outcomes. In addition, we attempt to explore the mechanisms that predict improved psychological and physical health. Finally, limitations of previous studies are highlighted, and suggestions for future research and application are made.     

Fear of psychological treatment and its relation to mental health service avoidance.

We evaluated whether a measure of mental health treatment fearfulness is associated with past mental health treatment history and/or current treatment status. Student Ss who either were or were not about to begin psychotherapy responded to the fear measure and a measure of psychological distress, and they also answered questions about their mental health treatment-seeking history. Analysis indicated that increased treatment fearfulness was associated retrospectively with a history of service underconsumption and cross-sectionally with a nonclinical treatment status. We conclude that treatment fears are associated with treatment-seeking decisions and suggest that future studies focus on delineating the causal relation of these variables and on the role that treatment fears may play in treatment compliance and behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Introduction to Special Section: A briefing on curative factors in dynamic psychotherapy.

Six samples of the newest and most innovative research on curative factors in dynamic psychotherapy are introduced in this special section: psychological health, capacities for interpersonal relationship, the therapeutic alliance, reliability and validity of dynamic formulations, capacity to internalize representations of the therapist and the therapy, and characteristics of accurate interpretations. The field shows increased reliance on clinical-quantitative research and decreased reliance on theory alone. The research is more reliant on short-term than on long-term therapy, and interventions are becoming increasingly focused and are evaluated in relation to outcomes of psychotherapy. The amount and quality of dynamic psychotherapy research on curative factors is clearly accelerating. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research contributions to improving managed health care outcomes.

Managed health care programs are beginning to look to findings from psychotherapy outcome research to help set policy, suggesting the need to consider outcomes research from the standpoint of usability or utility. It also provides an opportunity to integrate science and practice. Considering and applying outcomes in this context requires cooperation between scientists and practitioners, the willingness of each group to set aside guild agenda, and giving up favored but insupportable beliefs and practices on the parts of those in both scientist and practitioner camps. This type of cooperation may have mutual payoffs. This article considers some of the obstacles to this type of sacrifice and evaluates some of the potential costs of cooperating. It also provides perspectives on the new roles of psychological assessment and methods of outcome research that would provide a scientific basis for the function of managed health care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Negative effects from psychological treatments: A perspective.

The author offers a 40-year perspective on the observation and study of negative effects from psychotherapy or psychological treatments. This perspective is placed in the context of the enormous progress in refining methodologies for psychotherapy research over that period of time, resulting in the clear demonstration of positive effects from psychological treatments for many disorders and problems. The study of negative effects—whether due to techniques, client variables, therapist variables, or some combination of these—has not been accorded the same degree of attention. Indeed, methodologies suitable for ascertaining positive effects often obscure negative effects in the absence of specific strategies for explicating these outcomes. Greater emphasis on more individual idiographic approaches to studying the effects of psychological interventions would seem necessary if psychologists are to avoid harming their patients and if they are to better understand the causes of negative or iatrogenic effects from their treatment efforts. This would be best carried out in the context of a strong collaboration among frontline clinicians and clinical scientists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Future directions in studies of trauma among ethnoracial and sexual minority samples: Commentary.

Objective: Studies examining psychological trauma or posttraumatic stress disorder (PTSD) in ethnoracial or sexual minority groups are relatively few. The Journal of Consulting and Clinical Psychology recently published 4 articles (Balsam, Lehavot, Beadnall, & Circo, 2010; Harrington, Crowther, & Shipherd, 2010; Lester, Resick, Young-Xu, & Artz, 2010; Marshall, Schell, & Miles, 2009) that examine trauma exposure and posttraumatic outcomes in ethnoracial and sexual minority samples. This commentary focuses on the overlap between traumatic stress and diversity studies in order to consider future areas in need of development. Method: Within the framework of a generalized overview of current trends in the study of traumatic stress, an assessment of the strengths and limitations of these 4 articles is provided. Populations and syndromes covered by the articles include ethnoracial differences in child maltreatment and adverse mental health outcomes among sexual minority participants, PTSD symptom elevations among Hispanic Americans, binge eating and the strong Black woman schema, and retention of African American female participants in cognitive behavioral psychotherapy trials for PTSD. Results: Recommendations to enhance culturally competent traumatic stress studies include increasing the examination of within-group cultural variability and key social, contextual, and cultural variables and constructs; examining the temporal sequencing of traumatic events and key transitions in sexual and ethnic minority identity development; and conducting prevention and treatment studies for those sexual minority children most at risk for maltreatment. Conclusions: By following these recommendations, the next generation of studies of traumatic stress studies will be enhanced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal psychotherapy with men who experience gender role conflict.

Although research on men's gender role conflict reveals that it adversely affects men's psychological health and interpersonal relationships, psychotherapists typically underuse knowledge of masculine gender roles in psychological assessment and treatment. Interpersonal psychotherapy is proposed as a useful framework for working with men whose rigid enactment of traditional male gender roles leads to intrapersonal and interpersonal conflict (i.e., gender role conflict). Thus, this article integrates knowledge of male gender role conflict and interpersonal psychotherapy to examine issues that men who experience gender role conflict bring to their important interpersonal relationships and the therapeutic relationship. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing and Psychological Treatments.

Presents a comment on "Psychological Treatments" (see record 2004-21168-001) by D. H. Barlow. In his article, Barlow pointed to the need "to solidify the identification of psychology as a health care profession" by changing the terminology of practice in the health care context from psychotherapy to psychological treatments and suggested that the only persons qualified to carry out such interventions are doctoral-level psychologists. Unfortunately, there was no discussion of the health care professionals who already provide psychological treatments in health care settings and their contribution to the evidence base supporting such treatment. The authors find several aspects of the article to be problematic. Overall, the authors feel that suggesting that psychology should claim treatment of psychological disorders and psychological components of physical disorders in health care settings as exclusively its own domain ignores the research and clinical contributions of others. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Foreword.

The purpose of this special issue was to collect data and to bring to the attention of the psychological community the need for well-integrated high-impact psychological science and services in the overall health system. The reader will note by scanning titles of the various articles that this special issue is not a systematic review of literature. However, the articles contain valuable insights about the current state of the art on how psychotherapy interfaces with the general health system and the mental health system in particular. It must be noted that psychotherapy is a broad gauge concept involving a variety of applications and interventions which promote better health. It is evident from the contents herein that there is an evolution in the health care field regarding the incorporation of psychotherapy. That is, psychotherapy is becoming more a technique targeted toward specific problems or specific populations and subject to detachment from its scientific base. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward specific psychological therapies for specific conditions.

Comparative psychotherapy research has traditionally failed to find that one treatment is uniformly more beneficial than another. The lack of methodological and conceptual consistency among researchers, however, may have masked significant effects. This article presents a speculative model for predicting differential rates of therapeutic change. Through a review of 52 comparative psychotherapy studies, an effort was made to assess certain hypothesized relationships between the characteristics constituting the model and a variety of psychological treatment procedures. The use of the model for generating and guiding research is discussed. (69 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy with incarcerated offenders: A research synthesis.

The purpose of this study was to evaluate the efficacy of group psychotherapy with incarcerated offenders. Meta-analytic techniques were applied to 26 empirical studies that used a treatment group versus a control group. The outcome measures assessed in this study included institutional adjustment, anger, anxiety, depression, interpersonal relations, locus of control, and self-esteem. The results indicate that positive treatment effects were found for the use of group psychotherapy with incarcerated offenders across all outcomes. Supplemental analyses were also included to identify factors that contribute to the efficacy of group psychotherapy and indicate that the use of homework exercises resulted in significantly improved outcomes. Furthermore, participants mandated to treatment did not negatively influence the efficacy of group psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of psychotherapeutic treatments for PTSD: a meta-analysis of controlled clinical trials

This meta-analysis synthesized the results from controlled, clinical trials of psychotherapeutic treatments for posttraumatic stress disorder (PTSD). Psychotherapeutic modalities included behavioral, cognitive, and psychodynamic treatments, in group and individual settings. Participants in the studies included combat veterans from the Vietnam and Lebanon Wars, crime-related victims, and severe bereavement sufferers. The impact of psychotherapy on PTSD and psychiatric symptomatology was significant, d = .52, r = .25, when measured immediately after treatments were administered. Similarly, there was no decay in the effect of treatment at follow-up, d = .64, r = .31. Moreover, for target symptomes of PTSD and general psychological symptomes (intrusion, avoidance, hyperarousal, anxiety, and depression), effect sizes were significant, ranging from r's of .2-.49. Results suggest substantial promise for improving psychological health and decreasing related symptoms for those suffering from PTSD.     

Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research.

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (1) the overall effectiveness of psychotherapy for depressed clients, (2) its effectiveness relative to pharmacotherapy, and (3) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Video games in psychotherapy.

Video games have found their way into the clinical care of youth in most medical fields, and academic interest in their use is increasing steadily. The popularity of video games among youth may qualify them as a useful tool in psychotherapy for children and adolescents. Limited literature on use of video games in mental health care suggests that they can help young patients become more cooperative and enthusiastic about psychotherapy. Recent experience suggests that video games may facilitate therapeutic relationships, complement the psychological assessment of youth by evaluating cognitive skills, and elaborate and clarify conflicts during the therapy process. Concerns about video game content, perceived effects on youth, and lack of familiarity with this medium may form a barrier in their use in therapy offices. Further research on the benefits of video game use in psychotherapy, including patient characteristics that may moderate outcomes, is needed. Finally, future collaborations between clinicians and video game developers may produce specific games to be used in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)