Blog
The Psychotherapy Practice Research Network (PPRNet) blog began in 2013 in response to psychotherapy clinicians, researchers, and educators who expressed interest in receiving regular information about current practice-oriented psychotherapy research. It offers a monthly summary of two or three published psychotherapy research articles. Each summary is authored by Dr. Tasca and highlights practice implications of selected articles. Past blogs are available in the archives. This content is only available in English.
This month...
…I blog about therapist empathy, psychotherapeutic treatment for borderline personality disorder, and research on psychological treatment of depression.
Type of Research
Topics
- ALL Topics (clear)
- Adherance
- Alliance and Therapeutic Relationship
- Anxiety Disorders
- Attachment
- Attendance, Attrition, and Drop-Out
- Client Factors
- Client Preferences
- Cognitive Therapy (CT) and Cognitive-Behavioural Therapy (CBT)
- Combination Therapy
- Common Factors
- Cost-effectiveness
- Depression and Depressive Symptoms
- Efficacy of Treatments
- Empathy
- Feedback and Progress Monitoring
- Group Psychotherapy
- Illness and Medical Comorbidities
- Interpersonal Psychotherapy (IPT)
- Long-term Outcomes
- Medications/Pharmacotherapy
- Miscellaneous
- Neuroscience and Brain
- Outcomes and Deterioration
- Personality Disorders
- Placebo Effect
- Practice-Based Research and Practice Research Networks
- Psychodynamic Therapy (PDT)
- Resistance and Reactance
- Self-Reflection and Awareness
- Suicide and Crisis Intervention
- Termination
- Therapist Factors
- Training
- Transference and Countertransference
- Trauma and/or PTSD
- Treatment Length and Frequency
December 2013
Are The Parts as Good as The Whole?
Bell, E. C., Marcus, D. K., & Goodlad, J. K. (2013). Are the parts as good as the whole? A meta-analysis of component treatment studies. Journal of Consulting and Clinical Psychology, 81, 722-736.
Component studies (i.e., dismantling treatments or adding to existing treatments) may provide a method for identifying whether specific active ingredients in psychotherapy contribute to client outcomes. In a dismantling design, at least one element of the treatment is removed and the full treatment is compared to this dismantled version. In additive designs, an additional component is added to an existing treatment to examine whether the addition improves client outcomes. If the dismantled or added component is an active ingredient, then the condition with fewer components should yield less improvement. Among other things, results from dismantling or additive design studies can help clinicians make decisions about which components of treatments to add or remove with some clients who are not responding. For example, Jacobson and colleagues (1996) conducted a dismantling study of cognitive-behavioral therapy (CBT) for depression. They compared: (1) the full package of CBT, (2) behavioral activation (BA) plus CBT modification of automatic thoughts, and (3) BA alone. This study failed to find differences among the three treatment conditions. These findings were interpreted to indicate that BA was as effective as CBT, and there followed an increased interest in behavioral treatments for depression. However, relying on a single study to influence practice is risky because single studies are often statistically underpowered and their results are not as reliable as the collective body of research. One way to evaluate the collective research is by meta analysis, which allows one to assess an overall effect size in the available literature (see my November, 2013 blog on why clinicians should rely on meta analyses). In their meta analysis, Bell and colleagues (2013) collected 66 component studies from 1980 to 2010. For the dismantling studies, there were no significant differences between the full treatments and the dismantled treatments. For the additive studies, the treatment with the added component yielded a small but significant effect at treatment completion and at follow-up. These effects were only found for the specific problems that were targeted by the treatment. Effects were smaller and non-non-significant for other outcomes such as quality of life.
Practice Implications
Psychotherapists are sometimes faced with a decision about whether to supplement current treatments with an added component, or whether to remove a component that may not be helping. Adding components to existing treatments leads to modestly improved outcomes at least with regard to targeted symptoms. Removing components appears not to have an impact on outcomes. The findings of Bell and colleagues’ (2013) meta analysis suggest that specific components or active ingredients of current treatments’ have a significant but small effect on outcomes. Some writers, such as Wampold, have argued that the small effects of specific components highlight the greater importance of common factors in psychotherapy (i.e., therapeutic alliance, client expectations, therapist empathy, etc.). This may be especially the case when it comes to improving a patient’s quality of life.
Author email: david.marcus@wsu.edu
October 2013
Do Psychotherapists with Different Orientations Stereotype Each Other?
Larsson, B. P., Broberg, A. G., & Kaldo, V. (2013). Do psychotherapists with different theoretical orientations stereotype or prejudge each other? Journal of Contemporary Psychotherapy, 1-10.
A remarkable difference between the field of psychotherapy and other health care or scientific areas is that psychotherapy is organized in different and somewhat competing theoretical orientations or schools. Leading thinkers of psychotherapy integration, have emphasized how this division presents an obstacle to integration and therefore to progress within the practice and science of psychotherapy. One of these obstacles could be persistent stereotypes that psychotherapists might have about other therapists who practice from a different theoretical orientation. Social psychologists have long known that people in one group (e.g., an in-group) may misjudge or stereotype people in other groups (e.g., out-groups). Stereotypes may be negative if members of an in-group hold a positive bias toward their in-group coupled with antagonism toward members of an out-group. Do psychotherapists stereotype other therapists who practice from a different theoretical orientation? A recent study by Larsson and colleagues addressed this question. They surveyed 416 therapists divided into four ‘pure’ self-reported schools: 161 psychodynamic therapists, 93 cognitive therapists, 95 behavioural therapists, and 67 integrative/eclectic therapists. Most were women (76%), mean age was in the mid 50s, mean experience was 5 to 10 years, and they represented a variety of disciplines including psychology, psychiatry, social work, and nursing. In the first section of the survey, therapists indicated what focus they deemed most important to their own psychotherapeutic work, including: (1) therapeutic relationship, (2) patient’s thoughts, (3) patient’s feelings, (4) patient’s behaviour, or (5) connection between the patient’s thoughts, feelings, and behaviors. Therapists then estimated how they thought psychotherapists from other orientations would rate each of these foci. In the second section of the survey, therapists completed scales about what they deemed were important aspects of psychodynamic, cognitive, behavioral, and eclectic/integrative therapy, respectively. Once again, they rated how they thought therapists from the other orientations would respond. Self-ratings of therapists within each orientation indicated the ‘true’ (i.e., prototypical) opinions of each orientation. The differences between ‘true’ opinions of the in-group versus the in-group’s ratings of therapists from other orientations (i.e. of the out-group) indicated the level of misjudgement or stereotyping. Of the 18 areas on which out-groups were rated, 11 were significantly misjudged by the in-group. Eclectic/integrative therapists were much less likely to stereotype therapists of cognitive or psychodynamic orientations, who were equally likely to stereotype others. The belief that one’s own orientation compared to others is better characterized as an applied science (a belief endorsed most often by cognitive therapists) was a statistically stronger predictor of stereotyping than orientation per se.
Practice Implications
Some researchers argue that different orientations are more similar in their practice of psychotherapy than theory would predict. Furthermore, research about common factors in psychotherapy suggests that these factors may be more important than techniques specific to a school of psychotherapy. However, as long as there are different therapeutic orientations there will likely remain a tendency among some psychotherapists to search for differences rather than to look for similarities between their own and other orientations. This may lead to stereotyping (i.e., an inaccurate opinion about therapists of other orientations), and perhaps negative stereotyping. Psychotherapists and researchers may want to keep in mind the tendency to stereotype clinicians from other orientations when talking to or about other psychotherapists. Such stereotyping is likely an impediment to good client care and research.
Author email: billy.larsson@psy.gu.se