Week 2 Research Methods

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8/13/2019 Week 2 Research Methods

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Dee McKiernanCounselling Psychologist

Cert, B.A., MSc

Overview

Introductions

Module Descriptor

Discussion

What is Counselling Psychology?

About Counselling Psychology

What do Counselling Psychologists do?

Who do they work with?

TYPES OF PSYCHOTHERAPY

Types of psychotherapy:

Integrative psychotherapy:- combines previous types of therapy

Researching outcome of

psychotherapy

Does it work?

Outcome Measurement instruments

Perspective taken: Clients (they find changes)

Significant others and

Institutional data (less likely to find changes) Physiological data (small changes),

Behavioral data (if relevant can be sensitive tochange)

Therapists (likely to see changes, but it dependon context),

Extern expert raters (if do not know about therapylikely to find changes, if know even more likely

Lambert, Hill, 1994

Outcome Measurement instruments

Measured construct:

Personality questionnaires

Symptom self-reports Individual problems formulated by

client

Mental health constructs (e.g. self-esteem)

When do we talk about change?

Reliable Change Index: pre-post difference issignificantly bigger than error of measurementof the used instrument

Cut-off score – client gets to the norm

Clinically significant change: there is a reliablechange that goes beyond particular cut-offscore (Jacobson, Truax, 1991)

Size of the measured change:

Effect size: difference of the means of

compared groups is divided by their

average standard deviation

Effect sizes (Cohen’s d ): small

effect=0,3; medium effect=0,5; large

effect=0,8

Example of Pre - Post difference

Figure 2.1.1. Distributions of BDI scores of our illustrative example with the pretreatment mean score 25 (standarddeviation 7) and posttreatment mean score 10 with the same standard deviation.

Pre-treatmentPost-treatment

RANDOMIZED CLINICAL TRIALS

Randomized clinical trials (RCT)

Randomization and experimental control

Forms of control group:

placebo (double-bind condition problematic),

waiting list

alternative treatment

other bona fide psychotherapy

Randomized clinical trials (RCT)

Combined and dismantled designs

Types of measurement instruments

Acceptability of treatment

Follow-up (optimally at least 2 years)

Cost-effectiveness

Randomized clinical trials (RCT) -

Two psychotherapies for depression (cognitiveand interpersonal) were compared withantidepressants and drug placebo

Roughly 50% patients who started psychotherapywere without depression after 4 months

Approx. 25% or slightly more after 2 years

Elkin et al. (1989)

Alternatives to RCT:

Experimental case studies and complex

case studies

Trials based on clients preferences

Naturalistic studies

Surveys mapping consumers

satisfaction

Qualitative outcome studies

What do we know :

Average client treated in psychotherapy is better off than80% of untreated people (Smith et al., 1980)

Psychotherapy can alleviate moderate and mild forms ofdepression

CBT is very powerful in treatment of some anxietydisorders (e.g. panic disorder, Craske & Barlow, 2001)

About 5-10% of clients can get worse in the course of

therapy (Ogles & Lambert, 2004)

Long term psychotherapy with clients with personalitydisorders can bring significant improvement (Bateman &Fonagy, 2004)

Examples of dose-effect research:

Figure 2.5.2. The clinically significant recovery in time based on the sample of approximately 6.000 patients, who

completed psychotherapy (results regardless of diagnosis; mostly patients with affective, adjustment and anxiety

disorders) (adapted from Lambert, Hansen, & Finch, 2001).

Therapy session

P e r c

e n t a g e

o f p a t i e n t s

Process-outcome research:

What must happen in therapy, so the outcome was good

Some findings:

The quality of therapeutic relationship significantlypredicts the outcome (Horvath & Bedi, 2002)

Perfectionist clients have problem to form a stablealliance (Blatt et al., 2002)

Clients with insecure attachment have problem to form astable alliance (Meyer & Pilkonis, 2002)

More Findings:

Empathy of the therapist as perceived by the clientpredicts therapy outcome (Bohart et al., 2002)

Internalizing people benefit from relationships and

insight oriented therapies and externalizing people fromdirective and behaviorally oriented therapies (Beutler et

al., 2002)

Interpretations can be helpful for people who havereasonably good relationships (Crits-Christoph &

Connoly-Gibbons, 2002)

Descriptive process research:

Investigates impact of interventions

Investigates significant moments

Intensive case studies that were successful

Some findings:

- the clients defer to their therapists (Rennie, 1990)

- the clients have strategies for the sessions and

evaluate the therapists whether they are compatible withthese strategies (Rennie, 1990)

Descriptive process research:

Some findings:

The therapist admission of his/her contribution to the

tension in the therapeutic relationship helps resolve this

tension (Safran & Muran, 1996)

The clients can tolerate if the therapist interpretation is

not totally perfect (Elliott, 1984)

Successful interpretation is delivered in parts to the

client (Elliott, 1984)

Therapeutic ruptures

Testing theories of therapeutic change:

The therapy sessions are assessed as to their

compatibility with proclaimed theories

Some findings:

- the conflicts that clients have in relationships in their

life repeat themselves in the relationship with theirtherapist (Luborsky & Crits-Christoph, 1990)

- if the conflicts are worked through in therapy, the clientpsychopathology resolves as well (Luborsky & Crits-Christoph, 1990)

- the clients test their therapists if they can handleproblematic situations that the clients cannot handle; ifthe therapists do, it leads to improvement in the clientsfunctioning (Weiss & Sampson, 1986)

Testing therapeutic change:

Some findings:

- the clients who experienced deeper emotions in

emotion-focused therapy for depression show more

improvement than the clients who experienced lessemotions (Greenberg & Watson, 2005)

- the clients who explore fruitfully their feelings and

reflect on their meaning benefit from client-centredtherapy (Sachse & Elliott, 2001)

QUESTIONS

THANK YOU VERY MUCH

Week 2 Research Methods

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