View sample Eﬀectiveness of Psychological Treatment Research Paper. Browse other research paper examples and check the list of research paper topics for more inspiration. If you need a religion research paper written according to all the academic standards, you can always turn to our experienced writers for help. This is how your paper can get an A! Feel free to contact our research paper writing service for professional assistance. We offer high-quality assignments for reasonable rates.
Despite its relative youth, the ﬁeld of psychotherapy has faced many challenges, including one that disputed the very purpose it intended to accomplish. In a review of the eﬀectiveness of psychotherapy, Eysenck (1952) concluded that 74 percent of patients, drawn from 24 studies, and diagnosed as neurotic, were found to make progress considered equivalent to a similarly diagnosed group of individuals who received no treatment. This ﬁnding stimulated years of controversy regarding the eﬀectiveness of psychotherapy, as well as a determined and focused eﬀort on the part of researchers to establish empirically the beneﬁcial eﬀects, if any, of psychotherapy. In addition to reporting the ﬁndings supporting the eﬃcacy of psychotherapy treatment, the remainder of this discussion will present related ﬁndings from this eﬀort: (a) the durable eﬀects of psychological treatment, (b) the factors leading to patient improvement, and (c) the disturbing evidence that suggests that not all patients beneﬁt from treatment. Of related importance to this discussion is the paradoxical outcome that often accompanies many scientiﬁc investigations; namely, that as each question is suﬃciently answered, more questions take its place.
2. The Deﬁnition Of Psychotherapy
In general, psychological treatment is a method designed to change a person’s thoughts, feelings, or behaviors with the intention of facilitating increased functioning and life adjustment. Approaches to psychotherapy are numerous and diverse including such orientations as cognitive, behavioral, client centered, gestalt, and existential therapies. All of the various approaches involve a conﬁding relationship with a trained therapist focused on a patient in need of assistance.
3. The Eﬀectiveness Of Psychotherapy
As mentioned above, the conclusion made by Eysenck stimulated both the frequency and quality of studies designed to evaluate the outcome of therapy. Researchers pursuing evidence to refute Eysenck’s claim have investigated a number of domains that are considered relevant to distinguishing the eﬀects of psychotherapy. Assessments of the beneﬁts of psychotherapy have focused on such domains as an increase in problem-solving skills, reduction in symptoms, improvements in interpersonal and social functioning, and health. The changes noted in patients treated with psychotherapy have been compared to groups of individuals who have not been exposed to therapy. Reviews of this literature have conﬁrmed the beneﬁcial eﬀects of therapy, concluding that treated patients consistently fare better than untreated patients (Lambert and Bergin 1992, 1994).
An often used statistical technique, meta-analysis, has enabled researchers to summarize individual collections of empirical data, comparing the eﬀect sizes of treatment, placebo, and control groups. For example, using meta-analysis, Smith et al. (1980) reported that the average person in treatment is better oﬀ at the end of treatment than 80 percent of the untreated persons. A graphic representation of the eﬀect sizes (treatment, placebo, and control) found in a number of meta-analytic reviews is presented in Fig. 1.
4. Treatment Duration And Lasting Eﬀects
In contrast to the length of treatment associated with early theories of psychoanalytic psychotherapy, the extant literature suggests that substantial beneﬁts from treatment occur in relatively short durations, and equally important, these gains are maintained. Doseeﬀect designs, derived from the dosage model introduced by Howard et al. (1986), have conﬁrmed a positive rate of eﬀect as the dose (i.e., number of sessions) increases, with diminishing returns at higher dosage levels. Studies from the dose-eﬀect literature suggest that, for many clinical disorders, a range of 10 to 20 sessions is suﬃcient for 50 percent of patients to return to normal functioning. Moreover, promising results occur as the dosage level is increased to the extent that 75 percent of patients can be expected to recover substantially after 26 to 50 sessions (Lambert et al. 2001).
Although a majority of patients experience signiﬁcant beneﬁts from psychotherapy, there is also evidence that diﬀerent clusters of psychological symptoms respond to treatment at distinct rates of improvement. It appears that symptoms of poor morale respond most quickly, followed by chronic symptoms of distress, with symptoms intrinsic to the character of the patient recovering the slowest. Observed trends in patient improvement have led some researchers to propose a phase model of recovery in which personal welfare, symptom reduction, and interpersonal and social functioning improve in sequence.
In addition to results supporting relatively short recovery periods for a majority of patients, there is evidence that beneﬁcial gains from psychotherapy are enduring. Although adjustment from psychotherapy treatment does not prevent recurrences of psychological disturbance, it appears that many patients maintain healthy functioning for prolonged periods of time subsequent to treatment. However, exceptions to the notion of lasting treatment gains are noted in the conclusions of a review by Nicholson and Berman (1983), which included patients suﬀering from symptoms of substance abuse, eating, recurrent depression, and personality disorders.
5. Factors Important To Psychotherapy Outcome
In addition to the research focused on supporting the eﬀectiveness of psychotherapy, considerable emphasis has been placed on the factors attributable to positive patient outcome. Findings from this research fall into three general categories: patient variables, common variables, and speciﬁc intervention variables.
5.1 Patient Variables
Although a number of studies have investigated the impact therapists have on psychotherapy outcome, there is surprisingly little evidence that suggests therapists or their techniques are central and essential factors aﬀecting patient outcome. On the contrary, it is in fact the patient that is most likely to determine successful outcome. The literature focusing on the study of patient variables is too voluminous to repeat, and thus only the most important ﬁndings are reported here.
Each patient entering treatment brings a diverse array of factors when presenting to the clinician. These include a variety of psychological disorders, historical backgrounds, stresses, and the quality of their social support networks to name just a few. Patient variables found to have relationships with outcome are severity of disturbance, motivation and expectancy, capacity to relate, strength of ego, psychological mindedness, and ability to recognize relevant problems (Garﬁeld 1994). Therefore, patients suﬀering from challenging symptoms as well as relative deﬁcits in numerous patient variable categories are likely to experience negligible improvement during treatment. For example, the borderline, alcoholic patient with suicidal tendencies who is forced into treatment, believing that most marital problems are a result of an insensitive spouse, is likely to beneﬁt less from treatment than the depressed patient who voluntarily begins treatment and is determined to make personal changes that will lead to marital harmony.
Although patient variables have been conveniently categorized, the impact each has on the outcome of therapy is not equal. In general, the severity of disturbance is the patient variable that is most related to the outcome of the treatment. Patients with serious mental disorders, such as the schizophrenic, schizoaﬀective, and bipolar disorders are typically treated primarily with psychopharmacological management, suggesting the challenge these disturbances provide for psychotherapy alone. Personality disturbances also appear immutable to change in the short term use of psychotherapy.
5.2 Common Factors
Because outcome researchers have consistently failed to ﬁnd suﬃcient evidence indicating superior eﬀect sizes for particular theoretical modalities, some have concluded that psychotherapy equivalence is a result of factors common to all theories of psychotherapy. Whereas some view these beneﬁcial ingredients as both necessary and suﬃcient for change, others perceive that these ingredients act in coalition with variables that are unique to particular interventions. It is important to note that regardless of the position held, factors common to all treatments are likely to account for the greatest amount of the improvement in patients undergoing psychotherapy.
In a review of the empirical research, Lambert and Bergin (1994) grouped many of the shared active ingredients of a variety of psychotherapies into three categories: support, learning, and action factors. The factors included in these categories seem to operate most actively during the in-session process of therapy, resulting in a collaborative working relationship that allows clients to confront and cope with reality more eﬀectively. Factors that engender a collaborative relationship include a client’s increased sense of trust, security, and safety, along with a reduction in tension, threat, and anxiety that in turn promotes a client’s awareness of problems and ultimately new and more healthy perspectives on fears, appropriate risk taking, and motivations for resolving problems in interpersonal relationships.
Factors receiving the most attention in the literature are the common factors considered to be the core of therapy (empathy, warmth, and positive regard). A number of related terms such as acceptance, tolerance, therapeutic alliance, working alliance, and support are also used to describe these ingredients. In a study designed to explore which of several therapist variables distinguished most consistently between more eﬀective and less eﬀective therapist trainees, Laﬀerty et al. (1991) concluded that a client’s perception of empathy is important to outcome, because less eﬀective therapists, those with patients experiencing more distress as a result of treatment, were found to have lower levels of empathy.
Findings from studies investigating the therapeutic relationship have suggested that a positive working alliance between the patient and therapist is a necessary condition for patient improvement. When asked for factors that were most helpful in their treatment, patients tended to endorse the personal qualities of their therapists, using adjectives such as ‘sensitive,’ ‘honest,’ and ‘gentle.’ The results of similar studies conﬁrm the import that patients place on the characteristics of therapists (Horvath and Greenberg 1994).
Additional evidence supporting the necessity for a strong working relationship is the positive association repeatedly found between scores on measures of early treatment alliance and psychotherapy outcome. In clinical trial studies comparing multiple treatments for particular psychological disorders, patients’ positive assessment of the therapeutic alliance is one of the best predictors of psychotherapy outcome (e.g., Krupnick et al. 1996). Although a signiﬁcant amount of evidence points to common factors as mediators of patient change, the notion of beneﬁcial ingredients unique to speciﬁc therapies cannot be ruled out, as occasionally such interventions can be shown to contribute to successful outcomes in patients independent of common factors.
5.3 Speciﬁc Interventions
The drive to empirically validate the eﬃcacy of speciﬁc interventions is due, in part, to the ﬁeld of psychotherapy’s commitment to theoretically based approaches, as well as the inﬂuence of political and economic forces. Collectively, these factors have led to the use of comparative outcome studies, which generally avoid the ethical and methodological problems associated with no-treatment and placebo controls, while enabling researchers to study the eﬀectiveness of particular techniques or theories by comparison.
5.3.1 Anxiety Disorders. Speciﬁc behavioral treatments have been found to be eﬀective in treating patients with anxiety disorders. To date, two treatments, systematic exposure and applied relaxation techniques, have been shown to be eﬃcacious in treating a variety of anxiety disorders. Exposure is a broad term that encompasses both interoceptive and situational exposure interventions. Interoceptive procedures attempt to reliably produce panic-type sensations, with the intent of severing or weakening the patient’s associations between certain bodily cues and their respective reactions to panic. The technique of situational exposure, also known as in vivo exposure, refers to the patient’s repeated intentional encounters with a feared stimulus. Given the focus placed on the catalyst of fear, it is not surprising that clearly identifying the stimulus that induces the patient’s reactions is crucial for the success of these procedures.
Evidence suggests that the most eﬀective treatment strategy includes identiﬁcation of feared stimuli, confrontative periods of exposure suﬃcient in length to reduce the patient’s level of anxiety, and a focus on thoughts providing self-eﬃcacy or performance accomplishment. A general strategy employing the use of exposure techniques appears to be the only eﬃcacious intervention for agoraphobia (DeRubeis and Crits-Christoph 1998). Similar techniques have been shown to be successful for social phobic, panic, and post-traumatic stress disorder patients as well.
The results of a form of relaxation, referred to as applied relaxation, appear to show promise in treating speciﬁc anxiety disorders. Applied relaxation entails instructing patients in the skill of progressive muscle relaxation. Patients are generally taught how to progressively relax speciﬁc muscle groups. Whereas the evidence supporting the use of applied relaxation techniques alone is mixed in the panic disorder literature, it appears there is support for treating generalized anxiety disorder with relaxation training.
Additional evidence suggests that the treatment of speciﬁc disorders is most successful when particular interventions are combined with speciﬁc theory-based therapies. For instance, panic disorder is treated most eﬀectively when a cognitive-behavioral theory of therapy is used in tandem with behavioral techniques. Barlow et al. (1989) compared relaxation training (RT), imaginal exposure plus cognitive restructuring (E + C), and a combination of these two interventions (RT + E + C). Outcome was determined by the percentage of patients experiencing panic attacks. Results indicated that 36 percent of the WL (wait-list control) patients, 60 percent of the RT patients, 85 percent of the E C patients, and 87 percent of the RT + E + C patients were free of panic attacks at the end of treatment.
5.3.2 Depression. Like anxiety-based disorders, there is some evidence supporting the use of speciﬁc behavioral techniques in the treatment of depression; however, in the case of depression, these procedures are no more eﬀective than cognitive, interpersonal, and psychodynamic-interpersonal therapies. For example, behavioral activation alone, which refers to a patient scheduling activities that promote mastery as well as pleasure experiences, has been found to be as eﬀective as cognitive therapy. Whereas behavioral activation is a procedure that makes concerted eﬀorts to involve patients in constructive and pleasurable activities, cognitive therapy emphasizes the modiﬁcation of maladaptive thoughts, beliefs, attitudes, and behaviors of individuals. Although some researchers predicted the superiority of cognitive therapy’s ability to successfully treat depressive patients (Hollon and Beck 1986), the results of large well-controlled studies suggest that interpersonal and psychodynamic-interpersonal therapies are eﬃcacious as well. In contrast to the focus that cognitive therapy places on maladaptive thoughts, beliefs, and behaviors, the interpersonal theory perceives depression as the consequence of problems in the interpersonal history of the patient.
5.3.3 Eating Disorders. As eating disorders are generally characterized by harmful cognitions surrounding weight and physical image, cognitive and behavioral interventions have been the most extensively researched treatments. In particular, cognitive behavior therapy has been the focus of much research in the treatment of bulimia nervosa, showing promising results. However, it appears that interpersonal therapy provides generally equivalent results when long term follow-up ﬁndings are considered (Fairburn et al. 1993).
5.3.4 Substance Abuse Disorders. Reviews of the treatment of substance abuse disorders suggest that various therapy modalities have been found eﬀective in treating patients. Therapies that provide generally equivalent results are cognitive, cognitive behavior, and psychodynamic derived therapies. Whereas patients abusing alcohol have been treated, with similar success, using psychodynamic, cognitive behavior, and psychoeducational treatment modalities, opiate dependent patients have been treated with cognitive and supportive-expressive psychodynamic therapies with generally equivalent results.
Some caution should be applied when interpreting the above ﬁndings, however, as the results mentioned are typically based on randomized clinical trials. To date, there is little evidence suggesting that these ﬁndings generalize to the clinical setting. The question of whether one technique is comparatively unique and more eﬀective than another is a consistent topic in the literature of psychotherapy. There is currently little evidence supporting superiority of particular interventions, although future research may note unique contributions. For instance, there is a growing body of evidence suggesting that the use of therapy manuals allow for the detection of discernable diﬀerences in the behavior of therapists, while at the same time enhancing the eﬀects of speciﬁc therapy procedures. Perhaps these contributions will allow for more accurate comparisons in outcome studies. The search for speciﬁc techniques and common factors that distinguish successful treatment has proved to be diﬃcult because of the myriad factors that likely exist in the interactions between therapists and clients.
6. The Negative Eﬀects Of Psychotherapy
Findings from the study of the progress and outcome of patients undergoing psychotherapy have resulted in both expected and unexpected conclusions. Most patients receiving treatment improve, a minority of patients remain unchanged, and contrary to the intent of psychotherapy, some patients actually worsen as a result of treatment. Independent reviews of the literature suggest that there are patients who fail to achieve beneﬁcial gains from treatment. Although accurate estimates of patient worsening are diﬃcult to make because the results of such incidents are not often the focus of psychotherapy outcome studies, estimates of patient worsening vary between 0 and 15 percent (Lambert and Bergin 1992). Similar to patient improvement, it appears that the phenomenon of deterioration is equivalent across theoretical orientations. In addition, treatment failures are reported in all client populations, treatment interventions, and group and family therapies.
Despite what appears to be an equitable distribution of treatment failures, speciﬁc factors have been associated with deterioration. Consistent with the inﬂuence that patient variables often have in treatment success, patient characteristics appear closely linked to treatment failure. Severity of mental illness alone is predictive of unsuccessful outcome, and severe levels of mental illness in combination with speciﬁc interventions designed to breach, challenge, and undermine entrenched coping strategies and defense mechanisms are more likely to result in treatment failure. Consequently, psychotic, borderline, schizophrenic, and bipolar patients are those patients most frequently experiencing deterioration during the course of treatment. Similar ﬁndings have been reported in the psychoanalytic literature, as patients lacking quality interpersonal relationships, low anxiety tolerance at the inception of treatment, and low motivation were more likely to worsen when treated with psychoanalysis and purely supportive therapies, whereas patients treated with supportive-expressive psychotherapy enjoyed better outcomes. Deterioration is not unique to individual therapy, however. Reviews of group psychotherapy outcome have reported a positive correlation between treatment failure and patient variables such as low participation, poor self-esteem, poor self-concept, and more signiﬁcant needs for fulﬁllment. Additional personal characteristics associated with patient deterioration include hostility, interpersonal dysfunction, and negative expectations of treatment.
The above ﬁndings suggest that it is important to consider the type of intervention most appropriate for a particular client; however, harm is not the fault of patient and intervention alone. The results of studies investigating therapists’ contributions to the phenomenon of deterioration have suggested that speciﬁc therapists’ behaviors can lead to treatment failure. For instance, the results of a study investigating the relationship between therapist’s emotional adjustment, empathy, directiveness, support, and credibility, and patient outcome found that a therapist’s empathic abilities were the most predictive of patient outcome (Laﬀerty et al. 1991). Additional ﬁndings of the study suggested that eﬀective therapists were also likely to provide more direction and support than ineﬀective therapists. These researchers were also interested in the similarity in values held by the therapists and patients, and found that less-eﬀective therapists emphasized values, such as the importance placed on a life of comfort and excitement, whereas eﬀective therapists considered intellectual values, such as reﬂection, as more important.
Another study suggested that patient deterioration is related to therapist countertransference reﬂecting disappointment, hostility, or irritation (Mohr 1995). In addition, there was some indication that client deterioration is more prevalent when clinicians underestimate their client’s illness or overestimate their client’s progress in treatment. Research exploring the importance of leadership styles in group therapists suggests that confrontational and aggressive group therapists tended to have more treatment failures in their groups. These therapists were observed to be more likely to insist upon immediate client disclosure, emotional expression, and change in attitude.
Years of clinical research have produced compelling evidence for the value of psychotherapy. Contrary to Eysenck’s controversial publication regarding the eﬃcacy of psychotherapy, outcome studies have conﬁrmed that patients beneﬁt in a variety of domains from treatment. According to the dose-eﬀect literature, beneﬁts derived from therapy transpire in relatively brief periods of time. For many clinical disorders, generally one-half of all patients return to normal functioning in 10 to 20 sessions. An additional 25 percent of patients experience substantial improvement when dosage levels are increased to 30 to 50 sessions. The beneﬁts from treatment appear to be durable, as the results of follow-up studies suggest that the eﬀects of treatment endure for at least one to two years subsequent to treatment.
Not all patients experience the beneﬁcial eﬀects of treatment, and this ﬁnding has inspired the investigation of factors facilitating both positive and negative change. The results of such studies have indicated that a patient’s level of disturbance is most predictive of outcome; however, desire to change, interpersonal skills, ego strength, psychological mindedness, and awareness of relevant problems have all been found to be related to outcome. In addition to patient variables predictive of successful outcome, there are characteristics of a therapeutic relationship that facilitate a patient’s sense of trust, safety, and security. According to patients’ reports, therapist empathy and a strong therapeutic alliance are most predictive of treatment outcomes.
Although the use of speciﬁc interventions has showed promising results in the case of particular disorders, in general the search for superior treatment strategies has been disappointing, and according to some researchers unnecessary, given the complexity of potential interactions between therapists, clients, and modes of therapy. Regretfully, not all patients improve from treatment, indeed, some actually worsen. Knowledge of this phenomenon is somewhat limited; however, there is evidence that suggests that treatment failure is best predicted by severity of mental illness. Furthermore, factors inhibiting the development of a strong therapeutic alliance also predict negative outcome.
Although researchers have contributed empirical evidence supporting the eﬀectiveness of psychotherapy, they are just learning to understand why patients tend to improve. In time, it is likely that focused and determined research will eventually lead to greater insights into this important question.
- Barlow D H, Raske M G, Cerny J A, Klosko J S 1989 Behavioral treatment of panic disorder. Behavior Therapy 23: 507–28
- DeRubeis R J, Crits-Christoph P 1998 Empirically supported individual and group psychological treatments for adult mental disorders. Journal of Consulting and Clinical Psychology 66: 37–52
- Eysenck H J 1952 The eﬀects of psychotherapy. Journal of Consulting and Clinical Psychology 16: 319–24
- Fairburn C G, Jones R, Peveler R C, Hope R A, O’Conner M 1993 Psychotherapy and bulimia nervosa: Longer-term eﬀects of interpersonal psychotherapy, behavior therapy, and cognitive behavior therapy. Archives of General Psychology 50: 419–28
- Garﬁeld S L 1994 Research on client variables in psychotherapy. In: Bergin A E, Garﬁeld S L (eds.) Handbook of Psychotherapy and Behavior Change, 4th edn. Wiley, New York, pp. 190–228
- Hollon S D, Beck A T 1986 Cognitive and cognitive-behavioral therapies. In: Garﬁeld S L, Bergin A E (eds.) Handbook of Psychotherapy and Behavior Change, 3rd edn. Wiley, New York, pp. 443–82
- Horvath A O, Greenberg L S (eds.) 1994 The Working Alliance: Theory, Research, and Practice. Wiley, New York
- Howard K I, Kopta S M, Krause M S, Orlinsky D E 1986 The dose-eﬀect relationship in psychotherapy. American Psychologist 41: 159–64
- Krupnick J L, Sotsky S M, Simmens S, Moyer J, Elkin I, Watkins J, Pilkonis P A 1996 The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: ﬁndings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology 64: 532–9
- Laﬀerty P, Beutler L E, Crago M 1991 Therapeutic relationship and improvement as perceived by clients and therapists. Journal of Consulting and Clinical Psychology 57: 76–80
- Lambert M J, Bergin A E 1992 The achievements and limitations of psychotherapy research. In: Friedman D K (eds.) The History of Psychotherapy: A Century of Change. American Psychological Association, Washington, DC, pp. 360–90
- Lambert M J, Bergin A E 1994 The eﬀectiveness of psychotherapy. In: Bergin A E, Garﬁeld S L (eds.) Handbook of Psychotherapy and Behavior Change, 4th edn. Wiley, New York, pp. 143–89
- Lambert M J, Hansen N B, Finch A E 2001 Patient-focused research: using outcome data to enhance treatment eﬀ Journal of Consulting and Clinical Psychology 69
- Mohr D C 1995 Negative outcome in psychotherapy: A critical review. Clinical Psychology Science Practice 2: 1–27
- Nicholson R A, Berman J S 1983 Is follow-up necessary in evaluating psychotherapy? Psychological Bulletin 93: 261–78
- Smith M L, Glass G V, Miller T I 1980 The Beneﬁts of Psycho- therapy. Johns Hopkins University Press, Baltimore
- Wampold B E 1997 Methodological problems in identifying eﬃcacious psychotherapies. Psychotherapy Research 7: 21–43