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Article

Kathleen Someah, Christopher Edwards, and Larry E. Beutler

There are many approaches to psychotherapy, commonly called “schools” or “theories.” These schools range from psychoanalytic, to variations of insight- and conflict-based approaches, through behavioral and cognitive behavioral approaches, to humanistic/existential approaches, and finally to integrative and eclectic approaches. Different and seemingly new approaches typically have been informed by older and more established ones. For instance, cognitive behavioral therapy (CBT), one of the more widely used approaches, evolved from traditional behavior therapy but has become sufficiently distinct by adding its own complex variations so as functionally to represent an approach of its own. New approaches abound both in number and in complexity. Modern clinicians have had to become increasingly widely read and creative in trying to understand the ways in which patients may be helped. The sheer number of approaches, which has climbed into the hundreds, has challenged the field to find ways of ensuring that the treatments presented are effective. The advent of Evidence Based Practices (EBP) throughout the healthcare fields has placed the responsibility on those who advocate for particular types of treatment scientifically to demonstrate their efficacy and effectiveness. While this movement has brought standards to the field and has offered some assurance that psychotherapy is usually helpful, there remains much debate about whether the many different schools produce different results from one another. The debate about how best to optimize positive effects of psychotherapy continues, and there remain many questions to be asked of psychotherapy theories and of research on these approaches.

Article

Alan E. Kazdin

Research in psychotherapy has developed a number of treatments, numbering well over 300, that have a strong evidence base. These treatments can be applied to a broad range of psychiatric disorders (e.g., depression, anxiety, schizophrenia, and others) as well as other sources of impairment in psychological functioning among children, adolescents, and adults. This article provides an overview of evidence-based psychotherapies, including current advances in how treatments are applied. Examples of treatments for depression and autism spectrum disorder are provided to illustrate the diversity of procedures in use and how they are applied. Key challenges related to evidence-based psychotherapies are highlighted, and these include disseminating the research findings, so that effective treatments are being used in clinical practice, and devising novel ways of delivering treatment to reach the large number of individuals who are in need of psychological services but do not yet receive care.

Article

Two different but related developments played an important role in the history of psychologists in the fields of mental health care in Germany during the 20th century. The first development took place in the field of applied psychology, which saw psychological professionals perform mental testing, engage in counseling and increasingly, in psychotherapy in practical contexts. This process slowly began in the first decades of the 20th century and included approaches from different schools of psychotherapy. The second relevant development was the emergence of clinical psychology as an academic sub-discipline of psychology. Having become institutionalized in psychology departments at German universities during the 1960s and 1970s, clinical psychology often defines itself as a natural science and almost exclusively focuses on cognitive-behavioral approaches. There are four phases of the growing relationship between psychology and psychotherapy in Germany in which the two developments were increasingly linked: first, the entry of psychology into psychiatric and psychotherapeutic fields from approximately 1900 until 1945; second, the rise of psychological psychotherapy and the emergence of clinical psychology after World War II until 1972, when the diploma-regulations in West Germany were revised; third, a phase of consolidation and diversification from 1973 until the pivotal psychotherapy law of 1999; and fourth, the shifting equilibrium as established profession and discipline up to the reform of the psychotherapy law in 2019. Overall, the emergence of psychological psychotherapy has not one single trajectory but rather multiple origins in the different and competing academic and professional fields of mental health care.

Article

In clinical practice with older adults, depression is a common presenting problem and is usually interwoven with one or more life problems. These problems are often the focus of psychotherapy. Interpersonal Psychotherapy (IPT) is a highly researched and effective treatment for depression in adults and older adults. IPT is time-limited, and as an individual psychotherapy it is usually conducted over 16 sessions. IPT focuses on one or two of four interpersonally relevant problems that may be a cause or consequence of depression. These include: role transitions (life change), interpersonal role disputes (conflict with another person), grief (complicated bereavement), and interpersonal deficits (social isolation and loneliness). The four IPT problem areas reflect issues that are frequently seen in psychotherapy with depressed older people.

Article

Caring for an older adult who needs help or supervision is in many cases associated with mental and physical health issues, especially if the care recipient has dementia, although positive consequences associated with caregiving have also been reported. Several theoretical models have shown the relevance of psychological variables for understanding variations in the stress process associated with caregiving and how interventions may benefit from psychological techniques and procedures. Since the 1990s it has been witnessed an increment in the number of studies aimed at analyzing caregiver health and developing and testing interventions for decreasing caregiver distress. Several examples of interventions for helping caregivers are considered empirically supported, including interventions for ethnically and culturally diverse caregivers, with psychotherapeutic and psychoeducational interventions showing strong effect sizes. However, efforts are still needed to maintain the results of the interventions in the long term and to make the interventions accessible (e.g., through technological resources) to a large number of caregivers who, because of time-pressure issues associated with caregiving or a lack of support, are not benefiting from them. Making these interventions available in routine healthcare settings would help a large population in need that presents with high levels of psychological suffering.

Article

Simona C. Kaplan, Michaela B. Swee, and Richard G. Heimberg

Social anxiety disorder (SAD) is characterized by fear of being negatively evaluated by others in social situations. Multiple psychological interventions have been developed to treat SAD. The most widely studied of these interventions stem from cognitive-behavioral, acceptance-based, interpersonal, and psychodynamic conceptualizations of SAD. In cognitive-behavioral therapy (CBT), patients learn to identify and question maladaptive thoughts and engage in exposures to feared situations to test the accuracy of biased beliefs. Mindfulness and acceptance-based approaches to treating SAD focus on mindful awareness and acceptance of distressing internal experiences (i.e., psychological and physiological symptoms) with the ultimate goal of behavior change and living a meaningful life based on identified values. Interpersonal psychotherapy links SAD to interpersonal problem areas and aims to reduce symptoms by targeting interpersonal difficulties. Psychodynamic psychotherapy for SAD focuses on identifying unresolved conflicts that lead to SAD symptoms, fostering insight and expressiveness, and forming a secure helping alliance. Generally, CBT is the most well-studied of the psychological treatments for SAD, and research demonstrates greater reductions in social anxiety than pill placebo and waitlist controls. Results from randomized controlled trials (RCTs) suggest that mindfulness—and acceptance-based therapies may be as efficacious as CBT, although the body of research remains small; four of five RCTs comparing these approaches to CBT found no differences. RCTs comparing CBT to IPT suggest that CBT is the more efficacious treatment. Two RCTs comparing CBT to psychodynamic psychotherapy suggest that psychodynamic psychotherapy may have efficacy similar to CBT, but that it takes longer to achieve similar outcomes. RCTs examining CBT and pharmacotherapy suggest that the medications phenelzine and clonazepam are as efficacious as CBT for treating SAD and are faster acting, but that patients receiving these medications may be more likely to relapse after treatment is discontinued than patients who received CBT. Research generally does not indicate added benefit of combining psychotherapy with pharmacotherapy above each monotherapy alone, although this body of research is quite variable. Effectiveness studies indicate that CBT is equally effective in community clinics and controlled research trials, but studies of this nature are lacking for other psychological approaches.

Article

Scott O. Lilienfeld

Although psychotherapy is on balance effective for a broad array of psychological problems, a relatively small but steadily accumulating body of evidence suggests that at least some psychological interventions are harmful. Until recently, however, relatively little research attention has been paid to the identification of harmful psychological treatments. Although it has long been recognized that a nontrivial minority of people become worse following therapy, this finding does not necessarily mean that they have become worse because of therapy. Nevertheless, recent research has homed in on a small subset of interventions that may produce psychological harm, physical harm, or both. In addition, there is growing interest in pinpointing potential mechanisms of deterioration effects in psychotherapy, as well as in distinguishing harmful therapies from harmful therapists.

Article

Mary V. Minges and Jacques P. Barber

Psychodynamic psychotherapies (PDP) is an umbrella term for a variety of therapeutic modalities that have evolved out of the psychoanalytic/psychodynamic tradition, each theorizing a trajectory of human development that includes an etiology of and treatment for psychopathology. PDPs have in common the belief that people have an unconscious mind that influences thoughts and behaviors outside of the individual’s awareness. These processes operate from birth till death and are responsible for adaptive and maladaptive functioning at the level of interpersonal relationships and daily living. The psychodynamic therapist creates a case formulation for the individual seeking treatment, which incorporates a formal diagnosis with an understanding of the underlying dynamic factors contributing to the individual’s suffering. From this case formulation a treatment plan is created specific to the individual. During treatment, the therapist develops a strong working alliance while utilizing psychodynamic-specific techniques targeted at bringing insight into these unconscious thoughts and behaviors. Greater self-understanding enables greater choice ability and flexibility in functioning. In contrast to prevalent views, empirical research has found support for the efficacy of PDP in the treatment of mental disorders, including but not limited to: depression, anxiety disorders, somatic disorders, and personality disorders. In general, PDP was found more effective than control conditions and not different from active treatments. PDP effects have been shown to remain stable post treatment.

Article

Mind cure, or mental healing, was a late 19th-century American healing movement that extolled a metaphysical mind-over-matter approach to the treatment of illness. Emerging in New England in the mid-19th century out of a mix of mesmerism and metaphysical philosophies, due to its effectiveness, by the 1880s it achieved national recognition. Three individuals are credited with creating and popularizing mental (or metaphysical) healing: Phineas Parkhurst Quimby, Warren Felt Evans, and Mary Baker Eddy. Mind cure was appealing because it helped treat ailments for which the medicines of the day were ineffective, especially problems with the “nerves.” Mental healers employed non-invasive mental and spiritual methods to treat ailing people, called mental therapeutics. As a practice and therapeutic philosophy, mind cure is historically noteworthy because it shaped the earliest forms of psychotherapy in the United States, advanced therapeutic work within the realm of mind-body medicine, birthed the influential New Thought movement, and helped set the stage for the beginnings of religious pluralism and the positive reception of Asian meditation teachers in the West.

Article

A sociocultural-constructionist epistemology stands alongside more traditional psychology epistemologies for the study of aging. These positions are not commensurable. Based on Donald Peterson’s classic position on how science and practice differ in fundamental ways, on his view of “disciplined inquiry,” and Trierweiler’s view of the “local clinical scientist,” this epistemological position is more-directly relevant to practice. Within the constructionist context, it emphasizes the importance of “local” as a key level of description, along with particular levels of local knowledge. All of this is consistent with Knight’s Contextual Adult Lifespan Theory. Bruner’s ideas on cultural psychology and how culture is embedded in narrative take these ideas further. They are consistent with Bruner’s metacomments on epistemology.

Article

In a relatively brief period of time, the discipline of psychology in the United States changed from being mostly concerned with its status as a legitimate science, qua physics or biology, to a rapidly growing field caught up in the tensions between academic science and the practice of psychology as a mental health profession. The numerical growth of the field’s members was heavily concentrated in the professional areas of mental health application. This was due primarily to the changed conditions of postwar life and the concerns of policymakers about the mental health of citizens in a dynamic, fast-changing, and fast-paced society. Government funding for psychology dramatically increased, especially funds for training clinical psychologists and for conducting research on mental health problems. It was not long before many of the clinical psychologists moved away from solely academic work and into the private practice of providing psychotherapy to clients. The discipline’s main organizational body of the time was the American Psychological Association, which came under pressure to allocate intellectual, organizational, and financial resources to the support of its practitioner members. One of the most intense battles of this period was that of creating different training models for clinical psychology. The early postwar model placed priority on training clinical psychology students to be scientists first, but by the 1960s, the demand for greater emphasis on training for practice had to be addressed for the field to remain coherent. Along with the internal tensions, psychology had to come to terms with external pressures as well. Among its challenges were those from competing professions, such as medicine, to its legal and cultural authority to provide professional services. Psychology eventually won those battles, but only after a state-by-state fight. Psychology was also presented with the challenges of a society wrestling with social problems, such as the demands for equal civil rights and opportunities. By the late 1960s, there were increasing demands for inclusion of students and faculty of color in graduate training and while there were some successes, there remained challenges that endured into the 21st century.

Article

Scott O. Lilienfeld and Candice Basterfield

Evidence-based therapies stemmed from the movement toward evidence-based medicine, and later, evidence-based practice (EBP) in psychology and allied fields. EBP reflects a progressive historical shift from naïve empiricism, which is based on raw and untutored observations of patient change, to systematic empiricism, which refines and hones such observations with the aid of systematic research techniques. EBP traces its roots in part to the development of methods of randomization in the early 20th century. In American psychology, EBP has traditionally been conceptualized as a three-legged stool comprising high-quality treatment outcome evidence, clinical expertise, and patient preferences and values. The research leg of the stool is typically operationalized in terms of a hierarchy of evidentiary certainty, with randomized controlled trials and meta-analyses of such trials toward the apex. The most influential operationalization of the EBP research leg is the effort to identify empirically supported treatments, which are psychotherapies that have been demonstrated to work for specific psychological conditions. Still, EBP remains scientifically controversial in many quarters, and some critics have maintained that the research base underpinning it is less compelling than claimed by its proponents.