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Jack Malone

Introduction to psychology--PSY 101

HCPeer Review #1

Psychotherapy

2012, Vol. 49, No. 3, 276-290Joel M. Town, Allan Abbass, Ellen Driessen, Mark J. Diener, Falk Leichsenring, Sven Rabung

Section I: Description

Introduction:

This article, published by the one of the APAs scholarly journals, Psychotherapy, is

entitled A Meta-Analysis of Psychodynamic Psychotherapy Outcomes: Evaluating the Effects

of Research-Specific Procedures. As the articles title suggests, its authors examine the impact

of research-specific procedures (i.e. audio/video recording, treatment manuals, and fidelity

checks) on the outcomes of psychodynamic psychotherapy. The article begins by introducing the

three research-specific procedures it intends to investigate and some of the controversy

surrounding their use in evaluating the effectiveness of psychodynamic psychotherapy. Thus, the

overall purpose of the study is to demonstrate empirically the extent to

which use of research-specific procedures in psychodynamic psychotherapy effect outcomes

First, audio/video recording of therapy sessions is identified as a common research

procedure used in the training of therapists. Though, as the article notes, some fear that it may

undermine the therapeutic process by diminishing the level of trust between patient and therapist.

Second, the article discusses the use of treatment manuals in research and explains that

while, the empirical literature indicates that treatment manuals do not ensure effective delivery

of therapy the studies are less clear on whether they have a negative effect on treatment and

certain studies, note their limitations but overall support their clinical and training utility as a

source of 'conceptual support' for defining patient problems and guiding the content of

interventions...

Finally, the article considers the impact of treatment fidelity or the extent to which

therapy is delivered as intended. The two components of treatment fidelity are adherence

(whether the core components or techniques, typically described in a treatment manual, are

implemented) and treatment competence (the skill or accuracy with which these

interventions are delivered.)

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Sample:

The sample included 46 independent psychodynamic psychotherapy treatment samples

totaling 1,615 patients who took part in the study.

Methods:

The study detailed in the article included data from previously published studies. In all,

46 of the 71 separate samples were taken included based on the following: the treatments were

(a)... described by the authors as psychodynamic or psychoanalytic in nature, (b) was provided

in an individual or group format (e.g., not Internet delivered or self-help), and (c) applied verbal

techniques (e.g., treatments using art as a form of expression were excluded). All participants in

the studies were over the age of 18 and were reported to be experiencing common mental

disorders like depression or anxiety. The effects of the use of the three research-specific methods

were examined on the samples.

Analysis:

After examining the studies that found the effectiveness of psychodynamic treatments,

the researchers further examined the possible effects that audio/video recording, the use of

treatment manuals, and treatment fidelity on the results. Using various statistical methods the

researchers compared the outcomes of treatments that utilized the procedures and those that did

not.

Discussion:

The study further confirmed what the previous studies cited in the article found. That is,

mounting evidence shows the effectiveness of psychodynamic therapy. However, the study

explains that, the precise mechanisms of psychotherapeutic change remain unclear. Yet, the

study seems to suggest that examining how the research-specific procedures can reveal what is

actually delivered in psychotherapy. In other words, by further studying why the research-

specific procedures seem to create better outcomes we may shed light on what happens in the

minds of those who experience therapeutic change.

Conclusion:

The article concludes by explaining that research-specific procedures are not shown to

have a negative impact on therapy. Furthermore, these procedures outweigh the supposed

limitations on outcomes by showing that, significant treatment gains occurring after therapy

appear more likely

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when these research-specific procedures are used.

Section II: Application

I believe that articles like the one detailed above represent a positive trend in the field of

psychotherapy. Because there are a number of approaches to therapy, mental health clinicians'

perspectives have often been at odds. Some emphasize biology and brain chemistry. Others, like

Freudians and neo-Freudians emphasized childhood developmentwhich gave rise to the

psychodynamic approach. Perhaps as a pushback to the conservatism and rigidity that developed

within these approaches, and bolstered by scientific and empirical rigor, the cognitive approach

to the treatment of mental illness became very influential in the later half of the twentieth

century.

The findings of this study, in my view, helps move toward a synthesis of all three

approaches. In other words, it improves the prospects of a systems approach to treatment. By

demonstrating the empirical validity of psychodynamic treatments and research procedures that

improve their effectiveness, clinicians that may be skeptical of the effectiveness psychodynamic

psychotherapy may be led to embrace psychodynamic techniques in their practice. Similarly, as

science confirms the effectiveness of certain psychodynamic techniques, clinicians who are more

psychodynamically-oriented might more seriously consider the wealth of scientific evidence

associated with cognitive therapies.

In all, I view the trend toward more eclecticism to be positive. I believe that the more

therapists come to a collective understanding on what therapeutic techniques work for their

clients and why, the better the outcomes will be for clients. The article and the study it details is a

step in the right direction in terms of training therapists, investigating how therapeutic change

occurs, and understanding how to improve effective therapies.