Psychological Treatment Effectiveness, Seeking & Trends

Psychology Psychological Treatment Effectiveness, Seeking & Trends

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Effectiveness of Treatment

Research has shown that many people with psychological disorders benefit from treatment. Effectiveness depends on the specific disorder being treated and the skill of the therapist.

Ways of Assessing Effectiveness

The effectiveness of a particular therapeutic approach can be assessed in three ways: client testimonials, providers’ perceptions, and empirical research.

Client Testimonials

Clients who get treatment for psychological problems often testify to their effectiveness. However, such testimonials can be unreliable for several reasons:

  • Regression toward the mean: People often go into treatment because they are in extreme distress. When their distress becomes less extreme, they may attribute this to the treatment’s effectiveness. But even without treatment, extreme distress tends to decrease. The tendency for extreme states to move toward the average when assessed a second time is called regression toward the mean.
  • The placebo effect: People often feel better after being in treatment because of their expectations that they will improve. (See Chapter 1 for more information on placebo effects.)
  • The justification of effort effect: People may believe that treatment was effective because they spent time, effort, and money on it. If people work hard to reach a goal, they are likely to value the goal more. This phenomenon is called justification of effort.

Providers’ Perceptions

Treatment providers can say whether a treatment is effective, but this can be unreliable for several reasons:

  • Regression toward the mean affects providers’ perceptions of success. They may believe that a client who entered treatment in crisis became less extremely distressed because of the treatment. However, such an improvement may have occurred without any intervention.
  • Providers’ perceptions may be biased because clients often emphasize improvements in order to justify discontinuing treatment.
  • Providers may also have biased perceptions because they continue to hear from past clients only when those clients were satisfied with treatment. They don’t often hear from clients who found treatment ineffective.

Empirical Research

Another way to assess effectiveness is through careful empirical research. Research has shown that some treatments are more effective for a particular problem than a placebo or no treatment. These treatments are known as empirically validated treatments. Researchers have to conduct two or more studies in order to conclude that a specific treatment is effective for a particular problem.

Research shows that psychotherapy works for many psychological problems. Although people who do not receive therapy also sometimes improve with time, people who do receive therapy are more likely to improve. Research also shows that all approaches to therapy are about equally effective, though certain kind of therapies do seem somewhat more effective for specific problems.

Specific DisorderMost Effective Treatment
Panic disordersCognitive therapy
Specific phobiasSystematic desensitization
Obsessive-compulsive disorderBehavior therapy or medication
DepressionCognitive therapy
Post–traumatic stress disorder and agoraphobiaExposure treatment

Who Benefits from Treatment?

Clients who are likely to benefit from therapy share some common features:

  • Motivation to get better
  • Family support
  • Tendency to deal actively with problems rather than avoid them

Clients who are less likely to benefit from therapy also share some features:

  • Hostility and negativity
  • Personality disorders
  • Psychotic disorders

Can Therapy Be Harmful?

Under some conditions, therapy can be harmful to the client. Clients may be harmed if:

  • Therapists engage in unethical behavior, such as by having sexual relationships with clients
  • Therapists act according to personal prejudices or are ignorant of cultural differences between themselves and their clients
  • Therapists coerce clients into doing things they don’t want to do
  • Therapists use techniques that research has not demonstrated as being effective
  • Therapists lead their clients to produce false memories of past traumas through careless use of techniques such as hypnosis or free association

Seeking Treatment

Although many people experience psychological problems over their lifetime, not everyone seeks treatment. Not everyone is willing to get psychotherapy for problems they experience. More women than men get psychotherapy, and people who are more educated and who have medical insurance are also more likely to seek treatment.

Barriers to Getting Treatment

People may not seek treatment even if they feel they need it. Common barriers to getting treatment are:

  • Concerns about the cost of treatment
  • Lack of health insurance
  • The stigma associated with getting psychological treatment

Psychotherapy for Cultural and Ethnic Minorities

Modern psychotherapy is based on individualistic values, and many researchers have argued that such therapy may not be readily applied to ethnic minorities in the United States. Ethnic and cultural minorities may face several barriers to receiving psychotherapy:

  • Some cultural groups may be hesitant to seek help from professionals, particularly in institutional settings such as hospitals and clinics. They may instead prefer to seek informal help from family, friends, elders, and priests.
  • Cultural minorities may find it difficult to get psychotherapy services because therapists who speak their language are unavailable.
  • Therapists trained to treat mainly white, middle-class clients may not be familiar with or responsive to the needs of clients from different ethnic and cultural backgrounds.

Treatment Trends

Two current trends that affect the treatment of psychological disorders are managed care and deinstitutionalization.

Managed Care

Managed care is an arrangement in which an organization, such as a health maintenance organization (HMO), acts as an intermediary between a person seeking health care and a treatment provider. People buy insurance plans from HMOs and then pay only a small copayment each time they get healthcare services. Prior to managed care, health care was done through fee-for-service arrangements. In fee-for-service arrangements, people pay for any health care services they believe they need. They may then be reimbursed by insurance companies or government health care programs, such as Medicaid and Medicare.

The advantages of managed care are that consumers pay lower fees to providers and that money is not usually spent on medically unnecessary services.

Criticisms of Managed Care

Managed care systems have many critics who argue that HMOs compromise the quality of health care in the following ways:

  • Consumers are often denied treatment they need, or the length of treatment is inappropriately limited.
  • Managed care creates barriers to accessing health care services by requiring people to get referrals through their primary care providers or by authorizing only a small number of therapy sessions at a time.
  • Because of cost issues, the professionals who provide treatment are often less well-trained to treat severe disorders. For example, they may be counselors with master’s degrees rather than doctoral-level psychologists or psychiatrists.
  • Physicians might be required to prescribe older, less effective drugs rather than new drugs in order to keep costs down.
  • Clients’ confidentiality may be threatened because HMOs require therapists to disclose details about the clients’ problems in order to have treatment authorized.

The Community Mental Health Movement

In the past, people with psychological disorders typically received inpatient treatment at mental hospitals, or medical institutions that specialize in providing such treatment. In the 1950s, however, it began to be clear that mental hospitals often made psychological problems worse instead of better. Mental hospitals were very crowded and had few properly trained professionals, and they were often in less populated areas, giving patients little access to support from their friends and families.

In the 1950s, the community mental health movement started. This movement advocated treating people with psychological problems in their own communities, providing treatment through outpatient clinics, and preventing psychological disorders before they arose.

Because of the community mental health movement, deinstitutionalization became popular. Deinstitutionalization refers to providing treatment through community-based outpatient clinics rather than inpatient hospitals. Although people are still hospitalized for serious psychological problems, inpatient stays are usually relatively short and occur in psychiatric wings of general hospitals, rather than in mental hospitals far away from people’s communities.

  • Advantages of deinstitutionalization: Treatment at outpatient clinics is less costly than inpatient care and often just as effective. Also, people often prefer the freedom of community-based treatment to inpatient hospitals.
  • Disadvantages of deinstitutionalization: It has contributed to homelessness, since some people released from inpatient facilities have nowhere to go. Also, it has led to what is referred to as a “revolving door” population of chronically mentally ill people who are periodically hospitalized, released, and rehospitalized.

Quick Review

Types of Treatment

  • Treatment for psychological disorders can be categorized into insight therapiesbehavior therapies, and biomedical therapies.
  • All psychotherapies offer hopenew perspectives on a problem, and an empathic relationship with a therapist.
  • Many types of professionals provide psychological treatment.

Psychotherapy

  • All psychodynamic therapies are based on Sigmund Freud’s psychoanalytic treatment.
  • Psychoanalytic treatment focuses on uncovering unconscious motives, conflicts, and defenses.
  • Three techniques used in psychoanalysis are free associationdream analysis, and interpretation.
  • The concepts of transference and resistance are important features of psychoanalysis and current psychodynamic therapies.
  • Cognitive therapies attempt to identify and change maladaptive thinking patterns.
  • Cognitive therapists believe that depression arises from errors in thinking.
  • Cognitive therapists help clients to identify and change automatic thoughts and assumptions about the world.
  • Albert Ellis’s rational-emotive therapy is based on the idea that people’s feelings are influenced by their catastrophic thoughts and beliefs about events.
  • Behavior therapists focus on addressing symptoms rather than the underlying causes. They use learning principles to modify behavior.
  • Systematic desensitization is a type of exposure therapy that uses counterconditioning to decrease anxiety. It is effective at treating phobias.
  • Flooding is an exposure therapy in which patients are suddenly exposed to a feared object or situation.
  • EMDR is an exposure treatment for post-traumatic stress disorder and panic attacks. The eye movements do not appear to add to the effectiveness of the treatment.
  • In aversion therapy, a stimulus that evokes an unpleasant response is paired with a stimulus that evokes a maladaptive behavior.
  • Social skills training for improving relationships with people uses techniques such as modeling, behavioral rehearsal, and shaping.
  • token economy is a behavior modification program based on operant conditioning principles.
  • Humanistic therapists try to help people accept themselves and free themselves from unnecessary limitations.
  • In client-centered therapy, therapists provide a supportive emotional environment that helps clients enhance self-acceptance and personal growth.
  • Humanistic therapists believe that it is important to be genuine and empathic and provide unconditional positive regard.

Family Therapies

  • In family therapy, a therapist sees two or more members of a family at the same time. Family therapies are based on the idea that people live as interconnected members of families.
  • In couples therapy, therapists help couples to identify and resolve conflicts.

Group Therapies

  • In group therapy, a therapist meets with several people at once.
  • Groups may be homogeneous or heterogeneous.
  • In group therapy, the therapist screens participantspromotes a supportive environmentsets goals, and protects clients from harm.
  • Group members provide each other with acceptance, support, and honest feedback.
  • Self-help groups are similar to therapy groups, except that they do not have a therapist.

Biomedical Therapies

  • In drug therapy, psychological disorders are treated with medications. These medications are often effective but have many side effects.
  • Antianxiety drugs include benzodiazepines, which reduce central nervous system activity.
  • Antidepressants include MAOIstricyclics, and SSRIs. These drugs affect the levels of the neurotransmitters serotonin and epinephrine.
  • Antipsychotic drugs are used to treat schizophrenia and other psychotic drugs. They reduce dopamine activity.
  • Unlike the older antipsychotic drugs, the newer atypical antipsychotic drugs help treat the negative symptoms of schizophrenia. These drugs reduce serotonin activity as well as dopamine.
  • Lithium is used to treat bipolar disorders.
  • Drug therapies have been criticized for several reasons.
  • ECT is used to treat severe depression. It is a controversial procedure.
  • Lobotomies are performed only rarely to treat psychological disorders, but cingulotomies are sometimes done.
  • TMS is a recently developed noninvasive procedure for treating severe depression.

Effectiveness of Treatment

  • Client testimonials and providers’ perceptions are not reliable ways of assessing the effectiveness of treatments.
  • Empirical research shows that psychotherapy is effective for many problems.
  • All approaches to therapy are equally effective, but some approaches are more effective than others for specific problems.
  • Effectiveness does not depend on the therapist’s level of training, experience, or education but does depend on therapist skill. Effective therapists are empathicgenuine, and warm.
  • Clients who benefit from therapy tend to be people who are motivated, who are active problem solvers, and who have family support.
  • Under some conditions, therapy can be harmful to clients, such as if the therapist acts unethically or coerces the client in any way.

Seeking Treatment

  • People who seek psychotherapy are more likely to be womento be more educated, and to have medical insurance.
  • People may not seek treatment because of cost concernslack of insurance, or fear of stigma.
  • Cultural and ethnic minorities often face barriers to receiving psychotherapy.

Treatment Trends

  • In managed care systems, consumers pay lower fees to providers and money is not spent on unnecessary medical services. However, critics argue that managed care compromises quality of care in many ways.
  • There has been a trend toward deinstitutionalization over the past several decades.
  • Deinstitutionalization has both advantages and disadvantages.
Psychology Psychological Treatment Effectiveness, Seeking & Trends 
Psychology Psychological Treatment Effectiveness, Seeking & Trends

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