Blog

February 2013

• Does Participating in Research Have a Negative Effect on Psychotherapy?

  Town, J. M., Diener, M. J., Abbass, A., Leichsenring, F., Driessen, E., & Rabung, S. (2012). A meta-analysis of psychodynamic psychotherapy outcomes: Evaluating the effects of research-specific procedures. Psychotherapy, 49, 276-290.

  One of the main reasons that some clinicians do not participate in research is that they argue that doing so will have a negative impact on the therapeutic relationship, the therapy process, and patient outcomes. Although I have heard this from clinicians of many theoretical orientations, this opinion is perhaps most strongly held by some colleagues with a psychodynamic orientation. I identify with psychodynamic theory and practice, so this opinion about research held by some of my colleagues has been very disconcerting to me. Up to now, the best I could say in defense of practice-based research of psychodynamic therapy was to talk about my own experiences, which have been highly positive and rewarding. A recent meta analysis by Town and colleagues from Dalhousie University changes all that. (First, a note about meta analysis. Meta analysis is a statistical way of combining the effects of many studies, each of which has a number of participants, into a common metric called an effect size. By combining studies, the end result is more meaningful and more reliable than the results of any single study on its own.). The meta analysis by Town and colleagues had 45 independent samples and over 1600 patients. Results indicated that psychodynamic treatments for a variety of disorders (e.g., depression, anxiety, personality disorders) showed a significant large positive treatment effect – this is not new. What is new is that compared to conditions in which no research-specific protocols were introduced, conditions that did use research protocols were no different in terms of patient outcomes up to one year post treatment. There was even a significant small positive effect of these research protocols on outcomes from post treatment to one year post treatment. Research-specific protocols included video recordings of therapy sessions, therapists following treatment manuals, fidelity checks to make sure therapists were accurately doing psychodynamic therapy, and psychometric measurements of processes and outcomes

  Practice Implications

  Research protocols do not have a negative impact on psychodynamic therapy outcomes. Perhaps research protocols should be introduced into all therapies to improve longer term outcomes in addition to studying therapy procedures and processes that work.

  Author email: joel.town@dal.ca

• Increasing Attendance in Psychotherapy

  Oldham, M., Kellett, S., Miles, E., & Sheeran, P. (2012). Interventions to increase attendance at psychotherapy: A meta-analysis of randomized controlled trials. Journal of Consulting and Clinical Psychology, 80, 928-939.

  A great deal of clinical time can be wasted because of patient nonattendance at scheduled psychotherapy appointments. The financial costs of nonattendance are also high, and patients who need help but do not attend are not receiving help. Premature termination from psychotherapy is associated with poor outcomes. Previous reviews reported that premature termination rates in regular clinical practice ranged from 40% to 46.8%. Clearly this is a big problem for many psychotherapists and patients. Oldham and colleagues (2012) conducted a meta analysis of interventions to increase psychotherapy attendance. Their meta analysis included 33 randomized controlled trials (RCTs) representing 4422 patients. Interventions had a significant moderate effect on reducing premature termination and increasing attendance. Effective interventions included: giving patients a choice of appointment times, giving patients a choice of therapists, motivational enhancement interventions, preparing patients prior to psychotherapy on what to expect, attendance reminders, and providing information on how to make the best use of therapy. Participants with single diagnoses made better use of interventions than those with multiple diagnoses.

  Practice Implications

  Psychotherapists can improve attendance in psychotherapy by providing patients with choice of appointment times and therapists, by taking the time to prepare patients prior to therapy for what to expect in treatment and how to best make use of therapy, using motivational interventions, and by providing appointment reminders.

  Author email: s.kellett@sheffield.ac.uk or p.sheeran@sheffield.ac.uk