What is the placebo in psychotherapy?

Notes that, although there is extensive discussion of the placebo effect in psychotherapy, the distinction between the placebo and other elements of the therapeutic process has not been clear. The present discussion analyzes the therapeutic relationship in terms of separating the placebo elements and the specific factors. The so-called nonspecific elements often equated with the placebo are proposed to be specific factors, and it is contended that those variables studied as social psychological factors are actually part of the placebo. Three variables emphasized in the social influence model of psychotherapy are perceived expertness, attractiveness, and trustworthiness; research findings are consistent with the hypothesis that these variables are essentially placebos. Variables that have received support from research not involving analog situations are empathic understanding, respect or warmth, and therapeutic genuineness. These conditions are proposed as specific conditions for certain desirable outcomes in counseling or psychotherapy. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research on the effects of disconfirmed client role expectations in psychotherapy: A critical review.

Critically examines the pervasive assumption found in psychotherapy literature that disconfirmation of client role expectations has been demonstrated to be a negative influence in psychotherapy. When the empirical literature is examined, this hypothesis does not appear to be as conclusive as has been suggested. In fact, the empirical studies are evenly divided in supporting this hypothesis. The ambiguous state of the research is discussed in terms of problems in design and conceptualization: (a) The operationalization of the independent variable has often been inadequately precise or reliable. (b) The definition of expectation has usually not been clearly specified. (c) The theoretical base for almost all of the research may not be appropriate for the kinds of affectively toned expectations in psychotherapy. Future research should incorporate procedures to counter these types of problems. (72 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Structural analysis of social behavior as a common metric for programmatic psychopathology and psychotherapy research.

This article describes the use of the Structural Analysis of Social Behavior (SASB; L. Benjamin, 1974) as applied to programmatic psychodynamic-interpersonal psychotherapy research. SASB fosters cumulative, theory-driven research by permitting problem-treatment-outcome (PTO) congruence—the conceptualization and measurement of patients' problems, treatment processes, and outcome in a common metric. In this explication of the principle of PTO congruence, the following are discussed: a general model of interpersonal psychopathology and etiology, SASB-based assessment devices for measuring early history and formulating presenting problems, empirical studies of interpersonal process in therapy, the relationship between manual-guided training and interpersonal process, and the assessment of outcome. A generic interpersonal model of psychotherapy is proposed that theoretically links all of these elements. Finally, the use of these SASB-based models for cross-theory integrative research from a common-factors approach is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On the advantages of assuming that the techniques of psychotherapy are ineffective.

Contends that there are benefits to be gained from assuming that the specific techniques of psychotherapy are not the effective ingredients. The outcome literature is briefly reviewed, and 2 conclusions are reached: (1) Outcome is unrelated to the amount of training and experience of the therapist; and (2) outcome is unrelated to the specific techniques used. It follows that whatever is effective in therapy is to be found in the nonspecific factors common to the development of any relationship. This perspective can benefit the training of students by reducing their anxiety as they acquire clinical skills. It also has the advantage of reducing the dependencies often found in the therapeutic situation. (11 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Active Ingredients in Individual Psychotherapy: Searching for Common Factors.

Every serious school of psychotherapy has its own theory--often only vaguely formulated--concerning the active ingredients in psychotherapy. Many of these theories are presented as mutually exclusive. The author presents an overview of some of the important, primarily psychoanalytically founded, theories of the factors in individual psychotherapy that are responsible for inducing change. It is impossible to pinpoint any single factor that is crucial in every therapy. What is needed is a nondogmatic, multiple-factor model that successfully incorporates the knowledge obtained from the many existing theories of psychotherapy-induced change. In practice, it is often difficult to maintain the traditional distinction between specific and nonspecific factors, just as it is difficult to distinguish the roles played by purely therapeutic factors--relating to the technique of the therapist--and by extratherapeutic factors. The author also addresses the epistemological status of the various claims put forward, by the many different theories of psychotherapy, concerning the active ingredients in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Values, beliefs, religion and the persuasive influence of psychotherapy.

Psychotherapy has been conceptualized as a process of interpersonal persuasion. An often unrecognized implication of such an assumption is that the therapist's values and beliefs are transmitted to patients during the course of successful treatment. A review of available literature provides sufficient reason to believe that patients' values, attitudes, and beliefs change in psychotherapy and that to some degree these changes are associated with the degree to which therapy is successful. Research evidence suggests that patients acquire the specific values and attitudes of their own therapists rather than simply a more mature or adaptive set of beliefs. There appears to be some similarity between those parameters that affect therapeutic gain and those that affect persuasion in the social psychology laboratory. Such positive findings from the literature underline the importance of therapists taking cognizance of their own personal values as determiners of therapeutic gain. The findings highlight the necessity of research designed to investigate the role of specific values in this process. (78 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Non-verbal affective communication as a factor in psychotherapy.

Examines aspects of general and specific factors in psychotherapy as they relate to interpersonal variables identified in analytic literature and in empirical research. It is suggested that 1 of the reasons why interpretation of the research concerning the role of empathy and understanding in the successful patient–therapist relationship is difficult and the results unclear is that many aspects of the interpersonal environment are more subtle and complex than existing research implies. Therapists of many persuasions who wish to enhance the effectiveness of psychotherapy may need to examine some of the less obvious aspects of the therapeutic environment. Evidence suggests that nonverbal affective interactive states are important as change producing agents. Even when specific techniques are applied, emotional aspects of the therapeutic relationship may have a powerful effect. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Recipes for psychotherapy.

W. B. Stiles and D. A. Shapiro (see record 1995-10433-001) try to make a case for abandoning the model of drug research in exploring psychotherapy effectiveness, specifically, the idea that psychotherapy can be viewed in terms of effective "ingredients." Although provocative, their analysis can be challenged on methodological grounds involving failure to use multivariate analytic approaches, incomplete exploitation of advantages of growth curve analysis, and lack of attention to issues of statistical power. Acceptance of the conclusions proffered by Stiles and Shapiro would have negative effects on psychotherapy research and practice, and the case against the search for effective elements in psychotherapy process is not yet strongly made. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reducing psychotherapy dropouts: Maximizing perspective convergence in the psychotherapy dyad.

Reviews 3 decades of research addressing premature termination of psychotherapy. Client, therapist, interpersonal dyadic, and administrative variables have been extensively investigated. Because of a variety of methodological problems, this literature is highly contradictory, and results are difficult to reconcile, with only socioeconomic status (SES) and ethnicity emerging as consistent predictors of dropout. Treatment matching studies have evaluated the effects of maximizing similarity (or convergence) and minimizing perspective divergence within the therapeutic dyad. Research looking at interactive and multidimensional factors such as working alliance, client satisfaction and expectations, client likability, and pretreatment preparation has proven useful. This research suggests that psychotherapy dropouts might be minimized if differences between therapists' and patients' perspectives on therapeutic enterprise are acknowledged and recognized as legitimate targets for intervention. (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)     

Comment: Integrating methodologies in the scientific study of interpersonal psychotherapy: A reaction to "Therapist immediacy in brief psychotherapy: Case study I and case study II".

In this reaction article, the author concentrates on selected methodological components characterizing both Kasper, Hill, and Kivlighan's (see record 2008-13167-001) and Hill, Sim, Spangler, Stahl, Sullivan, and Teyber's (see record 2008-13167-002) respective case studies of therapist immediacy in brief psychotherapy. In tandem, the foci and methodology of these investigations break new ground in the scientific study of interpersonal psychotherapy, and more generally they serve as paradigmatic illustrations of the form that psychotherapy research can take if it is to be truly more meaningful and useful for practitioners. Emphasis is placed on the investigators' integration of single-case research, elements of change process research, and quantitative and qualitative methods in a way that enables highly intensive examination of this core intervention in interpersonal psychotherapy. Specific elements and implications of each of these methodological components are briefly discussed, which also creates a context for addressing the issue of discovery versus verification as this pertains to the present studies. Some underlying philosophical considerations are also briefly touched on along the way. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The therapist-as-fixed-effect fallacy in psychotherapy research.

Studies of psychotherapy involve sampling 2 sets of Ss from 2 populations: patients and therapists. Conclusions about psychotherapy should thus be based on statistical evidence that results are reliable across both patients and therapists. In most published research concerning psychotherapy, no statistical evidence is provided that findings can be generalized beyond the particular sample of therapists studied. In spite of this, researchers tend to draw conclusions concerning psychotherapy and therapists in general. ANOVA designs that allow generalization of results across both therapists and patients are described. The serious problems with inappropriate analyses of variance—treating therapists as a fixed effect or ignoring the therapist factor altogether—are discussed. A review of recently published studies of psychotherapy reveals that most researchers have done one or the other of these inappropriate analyses. (9 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

HIV counseling research needs suggested by psychotherapy process and outcome studies.

HIV risk reduction counseling is commonly used to prevent the spread of HIV. Such counseling is an interpersonal process that shares many characteristics with psychotherapy. Research on HIV counseling can benefit from methods and findings from psychotherapy research, and scientist-practitioners are well qualified to design or collaborate in studies that incorporate their expertise in psychotherapeutic process and in research. Studies of the relationship between the counselor and client, the structure of the counseling sessions, client experiences, and specific intervention techniques are suggested on the basis of consistent findings and important themes in psychotherapy literature. Research findings from studies adapting techniques and results from psychotherapy studies could significantly improve the effectiveness of current risk reduction counseling. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of psychotherapy and the concept of manualization: An integrative perspective.

In this article, the author examines some historical perspectives that may help psychologists who have recently been reading more about manualized treatments decide how to incorporate such information into contemporary practice. Even before the "age of manualization," each of the major schools of psychotherapy—psychodynamic, cognitive-behavioral, and family systems therapy—suffered from their own respective limitations in being unable to be exhaustive or definitive about the complexities that routinely take place in clinical practice. Perspectives on the role of manualized psychotherapy, the role of nonspecific factors and the therapeutic alliance, and the respective roles of professionalism and behavioral technology are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Toward delineating some causes of change in psychotherapy.

Contends that many psychotherapists are inclined to give credit to theories and methods that have little to do with the active ingredients of psychological change and growth. They overlook nonintentional influences (biological shifts, environmental changes, the process of maturation, in addition to several other factors) and attribute positive outcomes to specious techniques or cherished "truths" that collapse under scientific scrutiny. Yet there are data on the efficacy of discrete interventions for certain conditions, and despite claims to the contrary, specific therapies have been devised for specific symptoms. But negative effects can also result from psychotherapy. The art and science of effective psychotherapy consist of inspiring hope and achieving self-efficacy in the context of responsible guardianship. The latter implies the implementation of data-based clinical interventions whenever feasible. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis.

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness—known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)—may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The value of efficiency in psychotherapy.

While modern psychotherapies have often demonstrated a significant degree of effectiveness, in that they help clients overcome their presenting symptoms, their degree of "efficiency" may not measure up to their "effectiveness." Efficiency in psychotherapy includes several issues that are often neglected in research on "effectiveness." These criteria include such ingredients as depth-centeredness, pervasiveness, extensiveness, thoroughgoingness, maintenance of therapeutic progress, preventive psychotherapy, minimization of therapeutic harm, and encouragement of scientific flexibility. It is contended that these aspects of psychotherapy are of profound importance to therapists and clients and that such aspects should be consciously included as values in psychotherapy. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Translation in bilingual psychotherapy.

This model of translation was developed on a rational basis and first applied systematically in a case of intensive bilingual psychotherapy involving a 45-yr-old woman from central Mexico. Its primary demands are that translation be direct and concurrent. Technical problems of translation are discussed in detail, including the means of handling pronominal reversals, figures of speech, paralinguistic forms of expression, repetitiousness, and specific distortions of language usage resulting from mental illness. An operant procedure for conditioning the patients's length of utterance is outlined. Attention is given the various psychodynamic influences that shape the several interpersonal relationships that inform bilingual psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of psychotherapy as the basis for public policy.

Discusses the tremendous growth that has occurred in the number of mental health providers, the rate of use of mental health services, and public and private reimbursement for mental health care. Governmental policymakers and leading insurance officials continue to seek information regarding the appropriateness and efficacy of specific psychotherapeutic techniques with various types of presenting problems. The efforts during the Carter administration to stimulate additional efficacy research and knowledge synthesis regarding the efficacy of psychotherapy are described. A public policy proposal is forwarded that no form of health intervention—physical or mental—should be supported through 3rd-party reimbursement and publicly supported training programs unless it has been demonstrated to be safe and effective. It is argued that randomized controlled clinical trials should be viewed as the most valid, though not exclusive, source of evidence. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interpersonal self-confirmation and challenge in psychotherapy.

Six therapists and 45 university student clients participated in a study that tested predictions from interpersonal self-confirmation theory (e.g., J. Andrews; see record 1980-21500-001) and applied the predictions to psychotherapy. The prediction that higher levels of interpersonal challenge vs complementary relationships are experienced as more positively and negatively emotionally stimulating was confirmed. These findings support the application of the discrepancy hypothesis of D. Fiske and S. Maddi (1961) and D. McClelland et al (1953) to the realm of interpersonal self-confirmation and challenge. Qualitative data from a case illustration are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)