Psychotherapy and Counseling Essentials
Sommers-Flanagan, J. & Sommers-Flanagan, R. (2015)
Sigmund Freud has been called the father of modern psychotherapy.
[Q]: Can we give credit to one person for this title?
Early treatments for distress and psychological disturbance in humans can be grouped into four categories:
Believes in helping people deal with psychological concerns through medical or biological methods
Electroconvulsive therapy (ECT)
Vague nerve stimulation
Believes in treating psychological concerns through religious or spiritual measures
Clergy, shaman, and other spiritual leaders were previously consulted
Examples of contemporary approaches linked to spirituality:
Dialectical behavior therapy (DBT)
Acceptance and commitment therapy (ACT)
Believes in treating psychological concerns through verbal interactions and relationship alterations that are designed to change thinking patterns, mood, and behavior.
Focuses on the importance of considering culture and gender when designing treatments
Believes in treating psychological concerns through relationship-building and community
Counseling and Psychotherapy
Please review the definitions on pages 7-9
[Q] Are there differences between counseling and psychotherapy?
One definition of both counseling and psychotherapy suggests that each is a process that includes a trained professional:
Abiding by accepted ethical guidelines
With skills and competencies for working with diverse clients who are in distress or have life problems leading them to seek help or personal growth
Who establishes an explicit agreement to work together towards mutually agreed upon/acceptable goals
Using theoretically-based or evidenced-based procedures that have been shown to facilitate human learning, human development, or reducing disturbing symptoms
Research on Counseling and Psychotherapy
Published article on the effectiveness of psychotherapy based on 50+ years of data
Found that 2/3 of patients will recover or improve to a marked degree without therapy
Found an inverse correlation between recovery and psychotherapy! (This means psychotherapy was found to be more DAMAGING than having no treatment at all!)
Critics discovered his research was greatly flawed.
Mary Smith & Gene Glass
Developed meta-analysis (a new statistical method for combining information across different studies)
Evaluated 375 outcome studies
Concluded that clients treated with psychotherapy improved more than 75% of clients who received no treatment
Later expanded to consider 475 studies finding that a patient treated with therapy was 80% “better off” than the untreated patient
Although they clearly showed that psychotherapy works, they didn’t have clear evidence to suggest if one theoretical orientation/technique was better than another (Dodo bird effect)
Therapeutic Factors (Lambert)
Lambert identified four types of factors and estimated the degree to which each factor accounted for therapeutic change:
Believed to account for about 40% of client success
Includes numerous client factors such as:
Severity of disturbance
Client resilience/ego strength
Client support systems
Motivation to change
Ability to identify goals for counseling
Believed to account for about 30% of client success
Believed to be helpful in two ways:
Therapist factors such as unconditional positive regard and empathy promote positive response to therapy (Rogers)
Therapeutic alliance and an attachment between therapist and client, with the dyad working together for improvement, has been noted to promote positive response to therapy (Freud)
Believed to account for about 15% of client success
Can be viewed as hope or optimism that therapy will help.
Can be studied using placebos
Studies suggest that clients who receive placebos show more improvement than those who are untreated as well as those who take antidepressants
[Q] Why do you think this may be?
Believed to account for about 15% of client success by Lambert
Others have found technique to account for much less of client success
Techniques include whatever measures the professional uses in working with the client, such as exposure, cognitive restructuring, or hypnosis
Techniques with scientific research supporting its use are called empirically validated treatments (EVTs). EVTs are required to be manualized and shown superior to placebos and at least equivalent to other treatments
Competence and Informed Consent
Research suggests that competence can be developed through 3 strategies:
Working out your own issues
Working within a learning community
Engaging in skills practice and feedback
Informed consent = Clients’ rights to know about and consent to ways you intend to work with them. Also includes their right to know your training status, supervision arrangements (if applicable), techniques expected to be used, and expected length of time that counseling will occur.
D. Sue & D. W. Sue suggested that often, traditional counseling and psychotherapy have reinforced cultural stereotypes and forced minority clients to fit into a dominant, White American frame
Multicultural competencies focus on being competent in 3 areas:
Culturally specific techniques
Other Ethical Essentials
Limits to confidentiality should be explained to clients before/during the first session
Professionals should make all possible attempts to avoid due partially to power differential
Do no harm (the primary ethical mandate for all health professionals)
Doing No Harm
Research shows that psychotherapy results in negative outcomes for 3-10% of cases
Negative outcomes (causing client deterioration) is generally linked to 1 of 3 sources:
Specific psychological interventions
Most therapists are unaware of both their negative behaviors and negative treatment outcomes.
Research suggests 4 therapist factors may be linked to negative outcomes:
Therapists who show little empathy or warmth in their interactions with clients
Therapists who employ overly confrontational or intrusive therapy approaches
Therapists using inadequate or inaccurate assessment procedures (including culturally biased assessments)
Therapists whose personality or approach is a poor fit for a given client
Research suggests 3 client factors as potentially contributing to negative treatment outcomes:
Low client motivation
High client psychopathology (e.g., paranoia, antisocial behavior)
Limited client personal resources (e.g., limited IQ, insight, family/social support)
The best solution is for therapists to modify their approaches based on client!
Goodness-of-fit (between therapist/client & between client/technique) is important!
Examples of potentially harmful therapies
Rebirthing techniques (and other attachment therapies)
Recovered memory techniques
Boot camp interventions for conduct disorder
Grief counseling for people with normal bereavement reactions
Scared Straight interventions
How to Maximize Positive Outcomes
Try to use empirically supported treatments or evidence-based principles in your therapy practice.
Focus on building a positive relationship with your client.
Maintain high ethical standards
Maintain cultural sensitivity and multicultural competence
Remember to take care of yourself!
Maintain some flexibility in your approach and possibly tailor therapy techniques to your client and the situation