The relative efficacy of psychotherapy: Reassessing the methods-based paradigm.

Because the efficacy of behavioral interventions is central to applied psychology, the relative merits of competing approaches to an intervention are important. Many comparative studies examine the differential outcomes of alternative methods of psychotherapy. This paper addresses the issue of impact differences among rival intervention methods by focusing on treatment outcome research that emphasizes the relative (or comparative) efficacy of different psychotherapies. The paper has 4 components. First, it explores the concept of relative efficacy. Second, it reviews the extensive evidence on relative efficacy, which is generally consistent with the null hypothesis. Third, it offers a 3-part explanation of the negative evidence on relative efficacy: (a) a statistical argument about how relative efficacy is bound by a modest upper limit; (b) a research design argument about how relative efficacy studies are confounded by multiple factors, which make it difficult to demonstrate differences in treatment effects; and (c) a theoretical argument about how therapists' contributions to treatment outcomes depend more on their clinical abilities than the therapy methods they implement. The final section of the paper outlines questions for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The differential effectiveness of group psychotherapy: A meta-analytic perspective.

The differential effectiveness of group psychotherapy was estimated in a meta-analysis of 111 experimental and quasi-experimental studies published over the past 20 years. A number of client, therapist, group, and methodological variables were examined in an attempt to determine specific as well as generic effectiveness. Three different effect sizes were computed: active versus wait list, active versus alternative treatment, and pre- to posttreatment improvement rates. The active versus wait list overall effect size (0.58) indicated that the average recipient of group treatment is better off than 72% of untreated controls. Improvement was related to group composition, setting, and diagnosis. Findings are discussed within the context of what the authors have learned about group treatment, meta-analytic studies of the extant group literature, and what remains for future research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using Dissertations to Examine Potential Bias in Child and Adolescent Clinical Trials.

The major youth psychotherapy meta-analyses have relied on published studies, which may have led to biased effect size estimates. To examine this possibility, the authors compared 121 dissertations with 134 published studies and found the following: (a) few differences on individual methodological variables, but, overall, stronger methodology in dissertations; (b) no differences in the steps taken to ensure treatment integrity; and (c) a mean dissertation effect size less than half that of published studies. The effect size difference remained robust across tests controlling for all reliable method differences. The findings suggest that dissertations are so strong, both methodologically and clinically, that they warrant inclusion in child psychotherapy meta-analyses and that previous meta-analyses, by excluding them, may have overestimated treatment effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of psychodynamic psychotherapy.

Empirical evidence supports the efficacy of psychodynamic therapy. Effect sizes for psychodynamic therapy are as large as those reported for other therapies that have been actively promoted as “empirically supported” and “evidence based.” In addition, patients who receive psychodynamic therapy maintain therapeutic gains and appear to continue to improve after treatment ends. Finally, nonpsychodynamic therapies may be effective in part because the more skilled practitioners utilize techniques that have long been central to psychodynamic theory and practice. The perception that psychodynamic approaches lack empirical support does not accord with available scientific evidence and may reflect selective dissemination of research findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Methods and mechanisms in the efficacy of psychodynamic psychotherapy.

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler summarized a large body of research that shows psychodynamic therapy to have a substantial effect size, comparable to that for many empirically supported treatments. This is an important finding, in part refuting the concerns raised by Bornstein (2001, 2002) regarding the future of psychodynamic approaches had there been no substantial changes in how practitioners and researchers approached the science to demonstrate efficacy. Further, Shedler showed that the efficacy of psychoanalytic psychotherapy is due to therapeutic methods commonly employed in cognitive behavior therapy (CBT), one of the most frequently cited empirically supported approaches for a wide range of psychological conditions. From a methodological perspective, there are some important limitations to the claim of psychodynamic psychotherapy’s comparable efficacy to other empirically supported approaches. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A meta-analytic review of the effectiveness of inpatient group psychotherapy.

The effectiveness of inpatient group therapy was estimated in a meta-analysis of 24 controlled and 46 studies with pre-post-measures published between 1980 and 2004. Diagnosis, theoretical orientation and the role of the group in the particular treatment setting were used to examine differential effectiveness. Beneficial effects were found for inpatient group therapy in controlled studies (d = 0.31) as well as in the studies with pre-post-data (d = 0.59). Differences in the homogeneity of patient improvement effect sizes were found across different diagnostic categories. Furthermore, greater improvement was exhibited in mood disorder patients when compared to mixed, psychosomatic, post traumatic stress disorder (PTSD), and schizophrenic patients replicating recent findings from meta-analyses of outpatient group treatment. A comparison between controlled studies and pre-post-measure studies indicated no improvement for waitlist patients which contradicts previous reports. Implications for therapy and future research are discussed within the context of methodical considerations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The functional autonomy of psychotherapy.

Psychotherapy's initial function was to provide a service to troubled people who asked for help. Later evidence of its efficacy was unimpressive, but the method did not die out. "Psychotherapy had, it appeared, achieved functional autonomy." Various criticisms of the value of psychotherapy have been controverted. The efficacy of psychotherapy is not considered in the American Psychological Association ethical principles. Chapters on psychotherapy in the Annual Review of Psychology from 1955 to 1960 dismiss the question of efficacy. Experts are convinced that psychotherapy works. We "can be sure that the principle of functional autonomy will permit psychotherapy to survive long after it has outlived its usefulness as a personality laboratory." From Psyc Abstracts 36:02:2IE75A. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A pilot study of affect-focused psychotherapy for antepartum depression.

Logically, psychotherapy should be the first-line treatment for depression during pregnancy, yet there have been very few nondrug interventions tested in this patient population. The present study examines the impact of affect-focused psychotherapy as a treatment for antepartum depression. The treatment model was thought to be feasible to test with this population because depressed pregnant women are in need of an integrative model that can engage the client quickly and work rapidly to reduce symptom distress. Participants were 10 pregnant women with major depressive disorder who were treated with five sessions of affect-focused psychotherapy, as outlined in a published treatment manual. All therapy sessions were videotaped. Results indicate that participants experienced significant improvements in depressive symptoms, as well as increased therapeutic alliance and patient-therapist bond. These preliminary results provide promising data that demonstrate the effectiveness of a short-term (five-session) affect-focused psychotherapeutic treatment with a patient population suffering from antepartum depression. (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)     

Benchmarks for psychotherapy efficacy in adult major depression.

This study estimates pretreatment-posttreatment effect size benchmarks for the treatment of major depression in adults that may be useful in evaluating psychotherapy effectiveness in clinical practice. Treatment efficacy benchmarks for major depression were derived for 3 different types of outcome measures: the Hamilton Rating Scale for Depression (M. A. Hamilton, 1960, 1967), the Beck Depression Inventory (A. T. Beck, 1978; A. T. Beck & R. A. Steer, 1987), and an aggregation of low reactivity-low specificity measures. These benchmarks were further refined for 3 conditions: treatment completers, intent-to-treat samples, and natural history (wait-list) conditions. The study confirmed significant effects of outcome measure reactivity and specificity on the pretreatment-posttreatment effect sizes. The authors provide practical guidance in using these benchmarks to assess treatment effectiveness in clinical settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Learning psychotherapy in the digital age.

There is substantial literature documenting the process factors that lead to effective psychotherapy. Similarly, there is now a wealth of data attesting to the effectiveness of several psychotherapy brands. Little is known about the elements that facilitate learning how to be an effective clinician. One important step, after reading about a treatment model and seeing techniques demonstrated, is having the chance to practice the approach and receiving feedback and coaching from an experienced, knowledgeable supervisor. To accomplish this efficiently, most programs rely not only on trainee accounts of what went on in their therapy sessions, but also on recordings and videos of therapeutic encounters. This article describes our experience over a 5-year period in developing the use of Webcams for training psychology interns and psychiatric residents in the delivery of psychotherapy services. Pragmatic and technical details are given about how we went about establishing a recording system that is easy to use and provides secure, confidential storage of information at a reasonable cost. Discussion addresses both the weighing of choices that need to be made and overcoming the hesitation of trainees to reveal their work during treatment sessions. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Underreporting of psychopathology on the MMPI-2: A meta-analytic review.

Meta-analytic techniques were applied to studies of the MMPI-2 in which participants given standard instructions were compared with participants instructed or believed to have been underreporting. Traditional and supplementary indices of underreporting yielded a mean effect size of 1.25, suggesting that underreporting respondents differ from those responding honestly by a little more than 1 standard deviation, on the average, on these scales. Analyses of classification accuracy suggested that several scales are moderately effective in detecting underreporting, although accuracy decreases if participants have been coached about validity scales. Base rates of defensive responding in relevant populations are reviewed, and methodological issues, including research designs, coaching, and incremental validity of supplementary underreporting scales, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bias in psychotherapist ratings of client transference and insight.

The psychology literature at large considers rater bias to be a substantial source of error in observer ratings. Yet, it is typically ignored by psychotherapy researchers using participant (psychotherapist/client) ratings. In particular, interrater variability, or differences between raters' overall tendency to rate others favorably or unfavorably, has been a largely ignored source of error in studies that use psychotherapists and/or clients as raters. Ignoring rater bias can have serious consequences for statistical power and for interpretation of research findings. Rater bias may be a particular problem in psychotherapy research, as psychotherapists are often asked to rate subjective variables that require much rater inference. Consequently, we examined the extent to which rater bias is a factor in psychotherapist ratings of client transference and insight, by comparing psychotherapist variance from these ratings to psychotherapist variance in ratings of client-perceived emotional intelligence, using Hierarchical Linear Modeling. Results suggest that bias may be a substantial source of error in psychotherapist process and relationship ratings, accounting for, on average, 38% of the total variance in scores, and 30% after accounting for perceived emotional intelligence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of group psychotherapy for older adult clients: A meta-analysis.

This review examined the effectiveness of group psychotherapy for older (55+) adults. Results from 44 studies with pre-post designs and 27 controlled studies indicated that group psychotherapy benefits older adults, with average rs of .42 and .24 for pre-post and controlled designs, respectively. The type of therapy provided and the age of the clients were associated with pretreatment to posttreatment improvement. Clients in cognitive-behavioral group therapy improved more than those receiving reminiscence therapy. The older the average age of the group members, the less they benefited from therapy. Number of sessions attended, length of therapy sessions, the percentage of women in the group, and client living situation were not significant moderators of outcome. Overall, group interventions for older adults appear to be effective and the average effect size for pre-post studies was quite similar to those yielded by meta-analyses of group therapy with younger adults and adolescents. However, the average effect size for controlled studies of group therapy with older adults appears to be somewhat smaller than the values reported in meta-analyses with younger clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship between adult attachment style and therapeutic alliance in individual psychotherapy: A meta-analytic review.

The present study examined the relationship between adult attachment style and therapeutic alliance in individual psychotherapy. Search procedures yielded 17 independent samples (total N = 886, average n = 52, standard deviation = 24) for inclusion in the meta-analysis. Results indicated that greater attachment security was associated with stronger therapeutic alliances, whereas greater attachment insecurity was associated with weaker therapeutic alliances, with an overall weighted effect size of r = .17, p .10) with the exception of the source of alliance ratings; results indicated that patient-rated alliance demonstrated a significantly larger relationship with attachment compared with therapist-rated alliance (Qbetween = 3.95, df = 1, p = .047). Implications for clinical practice and future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comparative efficacy of individual and group psychotherapy: A meta-analytic perspective.

Recent reviews of the group psychotherapy literature indicate that group is a beneficial and cost-effective treatment format. However, collective findings on the differential efficacy of group when compared with individual therapy remain problematic, incomplete, or controversial. To remedy this problem, the authors conducted a meta-analysis of 23 outcome studies that directly compared the effectiveness of the individual and group therapy formats when they were used within the same study. Results were consistent with previous reports that indicated no difference in outcome between the group and individual formats. This finding generally held true when client, therapist, methodology, treatment, and group variables were examined for possible relationship with effect sizes comparing group and individual therapy. Results bolster past findings that group therapy can be used as an efficacious cost-effective alternative to individual therapy under many different conditions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance in individual psychotherapy.

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r = .275 (k = 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p     

Review of What works for whom? A critical review of psychotherapy research.

Reviews the book, What works for whom? A critical review of psychotherapy research by Anthony Roth and Peter Fonagy (see record 1996-98691-000). This book presents a comprehensive review of the status of psychotherapy research. The authors look at the evidence dealing with both efficacy and effectiveness of psychotherapy for the more common DSM-IV disorders. All of the chapters are geared toward the goal of providing the practitioner with a list of treatments for which there is empirical support. The reviewer notes that the amount of information covered in this text is extensive and provides sufficient evidence for the efficacy of psychotherapy for many of the diagnostic categories. Despite an overemphasis on cognitive/behavioral treatments, the authors do present the best of the research in psychodynamic therapy. The reviewer recommends this volume to both to researchers and practitioners. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The future of psychotherapy.

This "article" contains two blank pages, as an indication of G. W. Albee's concerns about the future of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)