Studying the effectiveness of psychotherapy: How well can clinical trials do the job?

Although there has been much discussion of the recent Consumer Reports (CR) study (1995) on the effectiveness of psychotherapy, there is little new information reported either in the CR article or in M. E. P. Seligman's (1995) discussion of the findings. The findings that are new are hard to interpret because of serious methodological problems. In fact, the CR study is similar in many ways to H. J. Eysenck's (1952) controversial report on the effectiveness of psychotherapy, a study that has been rejected by the field despite the fact that it avoided some of the methodological shortcomings of the CR study. It would be a mistake to put forth a design rejected in the 1950s as an exemplar of good effectiveness research, especially when better alternatives exist. Clinical trials, despite many limitations, can answer all of the questions posed by M. E. P. Seligman, without the interpretive ambiguities and other methodological problems inherent in surveys such as the one published in CR . (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy and effectiveness of psychotherapy: Two paradigms, one science.

Comments on M. E. P. Seligman's (see record 1996-13324-001) reanalysis of the 1995 Consumer Reports survey of the effectiveness of psychotherapy. The authors express concern that readers may draw from Seligman's arguments the erroneous conclusion that the transition from efficacy paradigms to effectiveness paradigms requires a relaxation of methodological rigor. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A new vision of personality...and of personality theory: Reply.

Replies to comments by Maddi (see record 2006-05893-007) on "A Tale of Two Visions: Can a New View of Personality Help Integrate Psychology?" (see record 2005-05480-001). In the original article, the current author proposed a new fieldwide framework for the discipline of personality psychology; in essence, it is a new outline to organize contemporary theory and research in the field. Maddi raised two interrelated objections to that proposed framework. First, he believes that there is a better way to organize the discipline of personality psychology than the one the current author proposed. His method involves comparing and analyzing the grand theories of personality and using the results of his analyses to guide research in the discipline. Maddi's (1968) meta-theory usefully organizes the statements of the grand theories of the early-to-mid-20th century, but the current author is not sure it is sufficient to organize the field. Second, he was concerned that the current author wants to de-emphasize the grand theories of the field. Maddi (2006) believes that disagreements among the grand theories are a fruitful source of research ideas. Although that may be true, there is more to personality psychology than the grand theories alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating "the Poor"--Classism or a Rigid Loyalty to Theory?: Comment.

Comments on "Psychotherapy, classism, and the poor: Conspicuous by their absence" by Laura Smith (see record 2005-11834-002). Smith suggested that social psychology theories might explain how a negative attitude toward the poor has reduced the interest of practitioners in poor patients. The current author was impressed by Smith's comments when she left the literature and began to describe her own experiences. However, the current author was not convinced that social psychology and the varieties of classism explain the phenomenon described. The current author believes that many practitioners avoid the poor because they do not enjoy failure. In this comment, the author discusses personal experiences that support this position. It does not elaborate a history of either a dislike of or class avoidance of the poor. Instead, it suggests that psychologists are trained to overgeneralize findings and to look down on less rigorously collected findings and observations. Thus, psychologists overlook information that might allow theories to be further formulated in more accurate and generalizable forms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cinema and the valuing of psychotherapy: Implications for clinical practice.

Cinema is riddled with negative portrayals of psychotherapy. In a media-saturated culture, public attitudes regarding the prevalence of mental illness, the symptomatology that defines abnormality, and the professionals who address such disorders are profoundly influenced by the images and messages in cinema and mass media. It is imperative for psychologists to maintain an awareness of the cinematic portrayals of psychotherapists, psychotherapy, and mental illness in order to better understand clients' expectations for therapy. By increasing awareness of the role of the media in shaping the image of professional psychology, clinicians can hope to decrease the stigma surrounding mental health care through engaging in discussions of these media stereotypes and advocating for more realistic portrayals of psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Therapists' race and African American clients' reactions to therapy.

This study examines the posttherapy reactions and attitudes of 44 African American clients seen at a university clinic in a midwestern city. Clients were randomly assigned to European American or African American therapists for 10 sessions of interpersonal or problem solving therapy. Therapy attitudes and reactions were assessed through clients' ratings of how well they understood and accepted the goals of therapy, their ability to accept and make use of therapeutic interventions, and perceptions of therapeutic benefit. The impact of European American therapists' efforts to cope with racial differences through therapist-initiated discussion of race in the first session or no therapist-initiated discussion of race were examined. African American clients' ratings of therapy indicated that there was a relationship between therapists' race and the understanding and acceptance of therapeutic interventions and perceived benefit of therapy. Clients rated therapeutic understanding and acceptance higher when assigned to an African American therapist. Therapists' initiation of or noninitiation of discussions of race had no affect on ratings of therapy. The clinical implications of these findings and suggestions for future research are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Correction to Schut et al. (2005).

Reports an error in "Therapist Interpretation, Patient-Therapist Interpersonal Process, and Outcome in Psychodynamic Psychotherapy for Avoidant Personality Disorder" by Alexander J. Schut, Louis G. Castonguay, Kelly M. Flanagan, Alissa S. Yamasaki, Jacques P. Barber, Jamie D. Bedics and Tracey L. Smith (Psychotherapy: Theory, Research, Practice, Training, 2005 Win, Vol 42(4), 494-511). The correct legend for Figure 1 on page 500 should read as follows: Figure 1. The SASB circumplex model, cluster version, interpersonal surfaces. Adapted from Benjamin (1993), Interpersonal diagnosis and treatment of personality disorders. New York: Guilford Press, copyright Guilford Press, and from: Benjamin (1987), Use of the SASB dimensional model to develop treatment plans for personality disorders, I: Narcissism. Journal of Personality Disorders, 1, 43-70, copyright Guilford Press. (The following abstract of the original article appeared in record 2006-03309-008.) The authors examined the link between interpretive techniques, the therapeutic relationship, and outcome in psychodynamic psychotherapy. Two independent teams of judges each coded one early session from patients diagnosed with avoidant personality disorder. Results revealed (a) an inverse association between concentration of interpretation and favorable patient outcome; (b) that small amounts of disaffiliative patient-therapist transactions before, during, and after interpretations were reliably or meaningfully associated with negative patient change; and (c) concentration of interpretation was positively associated with disaffiliative therapy process before and during interpretation and negatively associated with affiliative patient responses to interpretation. The results suggest that therapists who persisted with interpretations had more hostile interactions with patients and had patients who reacted with less warmth than therapists who used interpretations more judiciously. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological Treatments.

Psychology has recently identified itself as a health care profession and codified this change in the bylaws of the American Psychological Association. Although psychologists make a number of contributions to the nation's health-and mental health-the most identifiable activity focuses on treating physical or psychological pathology with psychological interventions. Recently, health care policymakers have established that evidence supporting the efficacy of these interventions is more than sufficient for their inclusion in health care systems around the world. To promote faster and more widespread dissemination of these interventions specifically targeting problems severe enough to be included in health care systems and to solidify the identification of psychology as a health care profession, perhaps it is time for a change in terminology. It is proposed that psychologists label these procedures psychological treatments so as to differentiate them from more generic psychotherapy, which is often used outside of the scope of health care systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

African Americans' Perceptions of Psychotherapy and Psychotherapists.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key banners to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Good, the Bad, the Obligatory, and the Virtuous: The Ethical Contexts of Psychotherapy.

Specific psychotherapy sessions and psychotherapy in general exist in the context of ethical questions and answers. Although psychotherapists often avoid them, questions about what is good, what is bad, obligations, and virtues (relatively stable, valued personal qualities) are an inescapable part of psychotherapy. Some ways psychotherapy raises (and answers) those questions are discussed in the context of a clinical case. The potential for ethical convictions to spark ethical conflict and divisiveness is explored, as is the potential for particular sorts of explicit reflectiveness about the ethical character of psychotherapy to be constructive and integrative. (PsycINFO Database Record (c) 2010 APA, all rights reserved)