Introduction to Psychotherapy Carolyn R. Fallahi, Ph. D.

The Psychotherapy Relationship What does it involve? –Shared information –Confidentiality –Strict limitations on the place and time of contact –Time-limited

Does Psychotherapy work? Eysenck’s work –1952 meta-analysis –24 published studies of “neurotic” patients. –None of the studies included a control group. –72% of neurotics recovered with non-specialized care. –Quasi-experimental –Concluded that therapy doesn’t work. –Response to that published work.

Smith & Glass (1977) Meta-analysis Rigorous design Looked at outcome literature Found a positive result average effect size for all psychotherapies was.85.

Lambert & Bergin (1994) ResearchersPatient diag/tx# of studiesEffect size Allen et al (1989)Public speaking97.51 Christensen et al (1987) OCD/exposure tx51.37 Mattick et al (1990)Agoraphobia Trull et al (1988)Agoraphobia Dobson (1989)Depression/Cog Tx Robinson et al (1989) Depression29.84 Gaffan et al (1995)Depression/Cog Tx11.93 Giblin et al (1985)Family Therapy85.44 Laessle et al (1987)Bulimia91.14 Lyons & Woods (1991) RET70.98 Benton & Schroeder (1990) Schizophrenia23.76

Empirically Validated Treatments Anxiety and Stress: –CBT for panic disorder –CBT for GAD –Exposure treatment for Agoraphobia –Exposure/guided mastery for specific phobia –Exposure and response prevention for OCD –Stress Innoculation training for coping with stressors

Empirically Validated Treatments Depression –Behavior therapy for depression –Cognitive therapy for depression –Interpersonal therapy for depression

Empirically Validated Treatments Health Problems –Behavior therapy for headaches –CBT for bulimia –Multicomponent CBT for pain associated with rheumatic disease –Multicomponent CBT with relapse prevention for smoking cessation

Empirically Validated Treatments Problems of Childhood –Behavior modification for enuresis –Parent training programs for children with ODD Marital Discord –Behavioral marital therapy

Therapeutic Skills What about therapy seems to be important? –30% of the variance = relationship factors. –Orlinsky, Grawe, & Parks (1994): reviewed 2,300 empirical studies and found that patient participation is the single most important outcome factor. –They need an encouraging, positive relationship.

Intervention techniques v. the relationship What’s more important? –Therapeutic technique? –The relationship? –The relationship*****

Therapist Skills Positive interaction Show interest Make the patient feel comfortable Offer encouragement and reassurance Instill hope Show sensitivity to patient feelings Offer practical assistance Empathy, warmth, and genuineness (Rogers)

Therapist Skills Eagan (1998). –genuineness –Warmth –How do we convey this?

Acquiring necessary skills Can you teach positive interpersonal skills? –Training –Common responses by novice therapists –Specific skills –EBM –Caring –Emotional involvement –How do you show caring?

Behaviors that make the patient wonder if the therapist cares. Overstructuring therapy Inappropriate self-disclosures Rigid use of transference interpretation Inappropriate use of silence Criticism Hostile tone or confrontational approaches

Do therapists care about all patients? Is it necessary to develop feelings of caring for the patient?

Coherence, Confidence, goals The treatment plan Techniques need to make sense Confidence on the part of the therapist Positive beliefs about therapy How do you translate complaints into goals?

Complaints and goals Vague goals versus specific goals. –Operationalizing goals. –Example, patient with ADHD.

ADHD Goals Psychoeducational Goals –Assign books on ADHD: The patient was referred to specific reading material designed to increase his/her knowledge about ADHD. –Teach Problem-solving skills: The patient was taught problem- solving skills that involve identifying the problem, brainstorming solutions, evaluating options, implementing action, and evaluat8ing results. –Teach self-control strategies: The patient was taught the self- control strategy of “stop, listen, think, and act” to assist him/her in curbing impulsive behavior. Conduct Psychological Testing –The patient was administered psychological testing in order to establish the presence of ADHD, a learning disability, and to assist with a description of strengths and weaknesses. Refer for Psychiatric Evaluation –Refer to a psychiatric for possible psychotropic medications.

Agreements and Contracts What does the therapist think? Offered after the first meeting. Provision that this plan will be updated. Initial treatment plan. Signed? Verbal agreement?

Comprehensive Treatment Plan Name: Date of first visit: Assets facilitating treatment: Barriers or challenges potentially interfering with treatment: Problem List: Goals, methods, Initial time frame: Patient informed Consent and participation: I have discussed this plan with Dr. Fallahi, understand it, and with my full and informed consent agree to the course of action outlined above. __________________________________________ Patient Signature Date

Building and maintaining the therapeutic relationship The first contact. The first telephone call.. Every interaction.

Building and maintaining the therapeutic relationship Active listening. Friendly interpersonal exchange. Synthesizing the information. Focus is on the patient. Avoid negative interchange. Resist distractions. Remember information about the patient. Don’t be judgmental.

What if the patient pushes your buttons? Supervision Referral?

Five indications of a good working relationship 1) Desire to see the patient. 2) Information is shared. 3) positive affect is expressed. 4) there is a sense of teamwork. 5) You can work out negative stuff.