CLASS SUMMARY: 8th , 11th, and 18th JAN.’10

GENERAL ISSUES IN PSYCHOTHERAPY
• DOES PSYCHOTHERAPY WORK?
Hans Eysenck after reviewing some of the early empirical studies on psychotherapy outcome, concluded that’s most clients got better without therapy and is of little benefit.
He was criticized for his claim and inspired thousands of subsequent empirical studies since then.
In 1970s and 1980s meta-analysis was the method of research. It statistically combines the results of many- in some cases, hundreds-separate studies to create numerical representation of the effects of psychotherapy as tested across massive number of settings, therapists and clients.
There are two types of psychotherapy research:
1. OUTCOME – comparing with other types of therapies
2. PROCESS- what actually happens at a micro-level in the session.
• WHO, WHEN AND HOW SHOULD RESEARCHER ASK?
As different people have different view points on the result of the therapy, the researcher has to decide on whom to consider. HANS STRUPP gave the tripartite model according to which there are three parties to be taken in account .
1. The first is the client
2. The second is the therapist
3. The third is the “society” i.e. any outsider to the therapy process who has an interest in how the therapy progresses.
As to when to ask one can ask question just after a session when the memory is fresh or after some time lapse after a week or month to test the effectiveness of therapy over time.
• EFFICACY V/S EFFECTIVENESS
Efficacy studies typically feature well-defined groups of patients usually meeting diagnostic criteria for a chosen disorder but no others; manualized treatment guidelines to minimize variability between therapists and random assignment to control and treatment groups.
It is more homogeneous and thus internal validity is high
Effectiveness studies tend to include a wider range of clients, including those with complex diagnostic profiles: allow for greater variability between therapists’ methods and may or may not include control group for comparison to treatment group. Thus internal validity is low and external validity is high and is more a heterogeneous group.
• WHICH THERAPY IS BEST?
Though there are many schools of psychotherapy each one is competent enough as all of the have some similar characteristics thus in psychotherapy the “dodo bird verdict” applies perfectly. Some of the common characteristics common among are as follows:
1. Relation between therapists and client
2. Support to client
? Affective experiencing
? Cognitive mastery
? Behavioral regulation
3. Some kind of learning
4. Action orientation- something to be done

UNCOMMON FACTORS:
? Patient/client’s characteristics
? Therapist’s characteristics
? Interaction/relationship between the therapists and clients

EXPERT’S ROLE
? Release of emotion
? Therapeutic alliance/relationship building

CLIENT’S/PATIENT’S CHARACTERISTICS
? The degree of patient’s distress
? Intelligence includes emotional intelligence, insight, willing to change, connecting things, verbal processes etc.
? Age – young adulthood
? Motivation
? Openness i.e. psychological mindedness
? Race, ethnicity and social class

THERAPIST’S CHARACTERISTICS
? Gender, age, and ethnicity
? Personality
? Empathy, warmth & genuineness
? Freedom from personal problems
? Experience & professional identification
According to Wolberg following are the desirable traits of a therapist
? Therapeutic personality
? Objective – less neurotic
? Flexible
? Level of ego strength
Undesirable traits are:
? Emotionally detached
? Excessive hostility
? Professional ego

• PSYCHOTHERAPEUTIC RELATION
? Background/Context (rf-encyclopedia of psychotherapy)
Therapeutic factors in the total range of psychotherapeutic intervention.
1. Non-specific : a. Affective Experiencing
b. Cognitive Mastery
c. Behavioral Regulation
2. Specific: a. Analytical Schools
b. Behavioral Schools
c. Experiential Schools
3. The Relationship As Therapeutic Factor: Psychotherapeutic changes always occur in the context of an interpersonal relationship and are to some extent extricable from it.
Simultaneous occurrence in different combination and emphasis.
? Transferential Relationship & Working Alliance
-special relationship between the therapist and the patient. Constitute both the subject and object of analysis
-primary stance: (original Freudian Room) transferential relations (therapist as a deliberate dispassionate observer and reflector of the patients feelings)* which many of us would not agree with.
-assymetrical therapeutic relationship
-secondary (more recent) stance: working or therapeutic alliance (holding the env., corrective relationship, empathic relationship)
Therapist aims at forming a real and mature (more satisfying) alliance with the conscious adult ego of the patient and encourages him/her to be a scientist partner in the exploration of difficulties (transference, resistance etc.)
? Teacher-Pupil Relationship
-used in behavior therapy
-deliberately structured
-therapist directly and systematically manipulates, shapes and inserts individual values in the therapeutic alliance (like a learning technician/social reinforcement machine)
-deliberately doesn’t dwell on the therapist-patient relationship. Secondarily done as relationship skill. *(this makes it easy for the behavioral therapist to leave the patient and transfer him to another’s care which is not so easy in any psychodynamic form of therapy, which is basically based on feelings and runs on time schedule)
-cognitive therapy : collaborative empiricism – tutorial approach
- patients share elements of both psychodynamic and cognitive approaches
? Person-to-Person Relationship (No power hierarchy)
-Rogerian/Expirential Approach
-here-and-now therapeutic dialogue or mutual encounter
-Egalitarian treatment model: alliance of human being to human being
“ I ENTER THE RELATIONSHIP NOT AS A SCIENTIST, NOR AS A PHYSICIAN WHO CAN ACCURATELY DIAGNOSE AND CURE, BUT AS A PERSON ENTERING INTO AN INTERPERSONAL RELATIONSHIP.”

• COURSE OF PSYCHOTHERAPY
? Initial Contact known as INTAKE
? ASSESSMENT PLAN both formal and informal. (first few sessions is to figure out what is the area of concern and major problems)
? TREATMENT PLAN that is GOAL SETTING. (every school has specific goal setting method)
? ACTUAL WORKING
? EVALUATION (home work, feedback etc). it is continuous in all session
? TERMINATION & FOLLOW UP
Even after termination the client will always has the right to come back.
Norcross has done research on the subject and has given changes of steps
? Precontemplation
? Contemplation
? Preparation
? Transformation/Action
? Maintenance
? Termination