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A behavioral psychological consultation program
Abstracts Comparative
Studies
of Psychotherapies.
Lester
Luborsky, Ph.D.
An overview of all reasonably well controlled comparisons of psychotherapies and psychotherapies with other treatments is presented. The main comparisons are: psychotherapy vs. group psychotherapy; time-limited vs. unlimited psychotherapy; psychotherapy as practiced by different traditional schools: client-centered vs. other traditional psychotherapies; psychotherapy vs. behavior therapy; psychotherapy vs. psychopharmacotherapy; psychotherapy vs. other treatments for psychosomatic conditions. I. Most comparative studies of different forms of psychotherapy found insignificant differences in proportion to patients who improved. This means that when psychotherapies are compared with each other, one finds that most comparisons show a “tie score”; that is, no significant differences, even though a high percentage of patients who go through nny of these psychotherapies profit from them. 2. This tie-score effect does not apply to psychotherapies vs. pharmacotherapies when applied singly-here pharmacotherapies do better. It must be considered, however, that in most of the controlled comparisons populations of patients tend to be ones where “drug” treatments seem more suitable. 3. Combined treatments tend to do better than single treatments; that is, psychotherapy plus pharmacotherapy does better than psychotherapy alone, or psychotherapy added to a medical regime for psychosomatic illness does better than a medical regime alone. There may be some mutually facilitative interaction benefit for the combined treatments. The paper concludes by considering the reason for the preponderance of tie scores. The explanation lays heavy emphasis on the major common component in different forms of psychotherapeutic treatments; that is, a helping relationship with a therapist. Psychotherapy
and the Sense of Mastery.
Jerome
D. Frank, M.D.
This paper summarizes evidence that loss of the sense of mastery over inner feelings or behavior is an important reason for seeking psychotherapy and that a successful therapeutic outcome is accompanied by a heightened sense of self-mastery. Ways in which different schools of individual and group therapy bring this about are described.
Evidence includes clinical observations such as the concept of phrenophobia, demographic studies which show that psychopathological symptoms alone may not be sufficient to cause persons to seek psychotherapy, and comparison of cohorts of persons in psychotherapy with those not in it, showing that the former more often complain of feelings of helplessness and failure. Evidence is cited that improvement in psychotherapy correlates with improvement in scores on tests related to mastery. All psychotherapies stress that the patient’s progress results ultimately from his own efforts, thereby heightening his sense of mastery. In addition, those aimed at increasing self-awareness enable patients to identify and label their experiences and incorporate them into a coherent conceptual framework. Behavior therapies provide continual success experiences through the therapist’s constant encouragement coupled with a structure that enables the patient to observe his progress at all times; emotional flooding procedures convince the patient that he can master the feelings or enter the situations he feared would overwhelm him. Existential therapies convey that even if he cannot control external events he can determine his reactions to them. Of group therapies, Recovery Incorporated focuses exclusively on convincing members that they can control their feelings and behavior; other group therapies enhance patients’ feelings of mastery by group encouragement, enhancement of self-awareness and demonstration that they can handle stressproducing interactions with others. These points are illustrated by experimental findings when available. A
Behavioral
gram.
Psychological
K. Daniel O’Leary
ond
Consultation Ronald
N.
ProKent,
Psychology Department, SUNY, Stony Brook, N.Y.
A psychological consultation program for children was evaluated for the treatment of elementary school children with academic and social problems (conduct disorders). The program employed a variety of treatment procedures which have been demonstrated to be effective in a number of classrooms, viz. contingent teacher attention, soft reprimands, a daily report card system with home-based reinforcement. Each of these major treatment procedures has been evaluated as a singular treatment procedure in individual subject and group designs rather than as part of a total 91
92
treatment
ABSTRACTS
program.
The purpose
of this
pro-
gram was to evaluate the effects of a total treatment program involving the child, his parents, and his teacher. Consultation was provided by four Ph.D.level therapists who were trained in behavior modification. The consultation was provided on approximately a weekly basis over 4 to 6 months. The effectiveness of the consultation program was evaluated by comparing 16 treated children with 16 non-treated children who were matched on: (1) observational rates of disruptive classroom behavior: (2) teacher ratings of classroom behavior; (3) California Achievement Test scores. Weekly observations of disruptive classroom behavior were obtained throughout the study. Pre-therapy and posttherapy comparisons were made on the California Achievement Test. Pre-therapy, midtherapy, and post-therapy teacher ratings were also obtained. All four therapists followed a standard and well-specified assessment and treatment plan. The details of the assessment and treatment plan for the parent and child, the fading of the therapist contact, the nature of the teacher consultation, evaluation of the treatment and six-month follow-up data will be presented. In addition, a paraprofessional model of this treatment will be presented.
The Efftcacy of
Psychotherapy
in
Depression.
Weissmon, M&W., Assistant Professor of Psychiatry, Yale University School of Medicine, Deportment of Psychiatry, New Haven, Conn.; Gerald L. Klerman, M.D.; Brigitte Prvsoff, M.P.H.; Barbara Hanson, M.S.W.; Eugene S. Paykel, M.D., Myrna M.
M.R.C.P.,
M.R.C.Psych.
Despite clinical reports attesting to the benefit of psychotherapy in the treatment of depression. there is an absence of any published controlled trials in a homogeneous sample of depressed patients. Findings will be presented on 150 recovering depressed women who were randomly assigned to receive either eight months of weekly psychotherapy from psychiatric social workers or monthly minimal contact. Patients were initially treated with amitriptyline and were part of a randomized drug trial. Treatment was on an outpatient basis. Social adjustment, as assessed by independent raters using a standardized scale measuring instrumental and affective role performance, was the main outcome measure ot psychotherapy. At the end of 8 months patients receivin&
psychotherapy
as contrasted
with minimal
con-
tact were better able to carry out their work, had decreased interpersonal tensions. improved communications and less impaired relations with close family members. These effects were not apparent for at least 6 months. An examination of the quantity and type of therapy showed that patient attendance was regular, treatment was primarily supportive, with emphasis on the “here and now” rather than reflective discussions or uncovering of early childhood material. Discussions centered around the patients’ current practical problems and family members. These results highlight the efficacy of supportive psychotherapy in enhancing the social adjustment of recovering depressed women. The improvement of the patients’ social and interpersonal adjustment has important presince most depressed ventive implications. patients are treated while at home where they are in close contact with their families and usually
are in caretaking
Outpatient A
Treatment
Comparison
Therapy.
RonaIdS.
and Leonard
of
roles.
of Neurotic Medication
Lipman,
R. Derogofis,
Ph.D.,
Depression: and
Group
Line Covi,
M.D.,
Ph.D.
This outpatient trial involved the douhleblind comparison of three medications: ((1) diazepam. a minor tranquilizer of’ the bcnzodiazeptne series: (h) imipraminc. a tricyclic antidepressant: and (c) placebo. Two kinds of’ non-somatic therapy were employed: (a) brief supportive contact. involving individual interviews of roughly 20 min, held hi-weekly. and (b)
psychodynamically oriented weekly group psychotherapy sessions of90 min duration. Chronically depressed neurotic women. who continued to evidence moderate depression after 2 wk of placebo administration. were randomly assigned to one of the six combmations of drug and psychotherapy, and to one ot two experienced psychiatrists (one with IO lr and the other with IX yr post-residenay e\per(ence) who partictpated in both treatment modalities at each of two Balttmvre cl~ntcs: (a) the Outpatient Department of the Henry Phipps Psychiatry Clinic of the Johns Hopkins Hospital and (h) the CIundry Hospttal Outpatient Department. Approximately I50 patients completed I6 wk of active treatment with reasonable compliance to study procedures, e.g.. regular attendance. taking me&cation as prescribed. completing self-rating measures of symptoms :rnd mood.
Studies
of Psychotherapies.
Lester
Luborsky, Ph.D.
An overview of all reasonably well controlled comparisons of psychotherapies and psychotherapies with other treatments is presented. The main comparisons are: psychotherapy vs. group psychotherapy; time-limited vs. unlimited psychotherapy; psychotherapy as practiced by different traditional schools: client-centered vs. other traditional psychotherapies; psychotherapy vs. behavior therapy; psychotherapy vs. psychopharmacotherapy; psychotherapy vs. other treatments for psychosomatic conditions. I. Most comparative studies of different forms of psychotherapy found insignificant differences in proportion to patients who improved. This means that when psychotherapies are compared with each other, one finds that most comparisons show a “tie score”; that is, no significant differences, even though a high percentage of patients who go through nny of these psychotherapies profit from them. 2. This tie-score effect does not apply to psychotherapies vs. pharmacotherapies when applied singly-here pharmacotherapies do better. It must be considered, however, that in most of the controlled comparisons populations of patients tend to be ones where “drug” treatments seem more suitable. 3. Combined treatments tend to do better than single treatments; that is, psychotherapy plus pharmacotherapy does better than psychotherapy alone, or psychotherapy added to a medical regime for psychosomatic illness does better than a medical regime alone. There may be some mutually facilitative interaction benefit for the combined treatments. The paper concludes by considering the reason for the preponderance of tie scores. The explanation lays heavy emphasis on the major common component in different forms of psychotherapeutic treatments; that is, a helping relationship with a therapist. Psychotherapy
and the Sense of Mastery.
Jerome
D. Frank, M.D.
This paper summarizes evidence that loss of the sense of mastery over inner feelings or behavior is an important reason for seeking psychotherapy and that a successful therapeutic outcome is accompanied by a heightened sense of self-mastery. Ways in which different schools of individual and group therapy bring this about are described.
Evidence includes clinical observations such as the concept of phrenophobia, demographic studies which show that psychopathological symptoms alone may not be sufficient to cause persons to seek psychotherapy, and comparison of cohorts of persons in psychotherapy with those not in it, showing that the former more often complain of feelings of helplessness and failure. Evidence is cited that improvement in psychotherapy correlates with improvement in scores on tests related to mastery. All psychotherapies stress that the patient’s progress results ultimately from his own efforts, thereby heightening his sense of mastery. In addition, those aimed at increasing self-awareness enable patients to identify and label their experiences and incorporate them into a coherent conceptual framework. Behavior therapies provide continual success experiences through the therapist’s constant encouragement coupled with a structure that enables the patient to observe his progress at all times; emotional flooding procedures convince the patient that he can master the feelings or enter the situations he feared would overwhelm him. Existential therapies convey that even if he cannot control external events he can determine his reactions to them. Of group therapies, Recovery Incorporated focuses exclusively on convincing members that they can control their feelings and behavior; other group therapies enhance patients’ feelings of mastery by group encouragement, enhancement of self-awareness and demonstration that they can handle stressproducing interactions with others. These points are illustrated by experimental findings when available. A
Behavioral
gram.
Psychological
K. Daniel O’Leary
ond
Consultation Ronald
N.
ProKent,
Psychology Department, SUNY, Stony Brook, N.Y.
A psychological consultation program for children was evaluated for the treatment of elementary school children with academic and social problems (conduct disorders). The program employed a variety of treatment procedures which have been demonstrated to be effective in a number of classrooms, viz. contingent teacher attention, soft reprimands, a daily report card system with home-based reinforcement. Each of these major treatment procedures has been evaluated as a singular treatment procedure in individual subject and group designs rather than as part of a total 91
92
treatment
ABSTRACTS
program.
The purpose
of this
pro-
gram was to evaluate the effects of a total treatment program involving the child, his parents, and his teacher. Consultation was provided by four Ph.D.level therapists who were trained in behavior modification. The consultation was provided on approximately a weekly basis over 4 to 6 months. The effectiveness of the consultation program was evaluated by comparing 16 treated children with 16 non-treated children who were matched on: (1) observational rates of disruptive classroom behavior: (2) teacher ratings of classroom behavior; (3) California Achievement Test scores. Weekly observations of disruptive classroom behavior were obtained throughout the study. Pre-therapy and posttherapy comparisons were made on the California Achievement Test. Pre-therapy, midtherapy, and post-therapy teacher ratings were also obtained. All four therapists followed a standard and well-specified assessment and treatment plan. The details of the assessment and treatment plan for the parent and child, the fading of the therapist contact, the nature of the teacher consultation, evaluation of the treatment and six-month follow-up data will be presented. In addition, a paraprofessional model of this treatment will be presented.
The Efftcacy of
Psychotherapy
in
Depression.
Weissmon, M&W., Assistant Professor of Psychiatry, Yale University School of Medicine, Deportment of Psychiatry, New Haven, Conn.; Gerald L. Klerman, M.D.; Brigitte Prvsoff, M.P.H.; Barbara Hanson, M.S.W.; Eugene S. Paykel, M.D., Myrna M.
M.R.C.P.,
M.R.C.Psych.
Despite clinical reports attesting to the benefit of psychotherapy in the treatment of depression. there is an absence of any published controlled trials in a homogeneous sample of depressed patients. Findings will be presented on 150 recovering depressed women who were randomly assigned to receive either eight months of weekly psychotherapy from psychiatric social workers or monthly minimal contact. Patients were initially treated with amitriptyline and were part of a randomized drug trial. Treatment was on an outpatient basis. Social adjustment, as assessed by independent raters using a standardized scale measuring instrumental and affective role performance, was the main outcome measure ot psychotherapy. At the end of 8 months patients receivin&
psychotherapy
as contrasted
with minimal
con-
tact were better able to carry out their work, had decreased interpersonal tensions. improved communications and less impaired relations with close family members. These effects were not apparent for at least 6 months. An examination of the quantity and type of therapy showed that patient attendance was regular, treatment was primarily supportive, with emphasis on the “here and now” rather than reflective discussions or uncovering of early childhood material. Discussions centered around the patients’ current practical problems and family members. These results highlight the efficacy of supportive psychotherapy in enhancing the social adjustment of recovering depressed women. The improvement of the patients’ social and interpersonal adjustment has important presince most depressed ventive implications. patients are treated while at home where they are in close contact with their families and usually
are in caretaking
Outpatient A
Treatment
Comparison
Therapy.
RonaIdS.
and Leonard
of
roles.
of Neurotic Medication
Lipman,
R. Derogofis,
Ph.D.,
Depression: and
Group
Line Covi,
M.D.,
Ph.D.
This outpatient trial involved the douhleblind comparison of three medications: ((1) diazepam. a minor tranquilizer of’ the bcnzodiazeptne series: (h) imipraminc. a tricyclic antidepressant: and (c) placebo. Two kinds of’ non-somatic therapy were employed: (a) brief supportive contact. involving individual interviews of roughly 20 min, held hi-weekly. and (b)
psychodynamically oriented weekly group psychotherapy sessions of90 min duration. Chronically depressed neurotic women. who continued to evidence moderate depression after 2 wk of placebo administration. were randomly assigned to one of the six combmations of drug and psychotherapy, and to one ot two experienced psychiatrists (one with IO lr and the other with IX yr post-residenay e\per(ence) who partictpated in both treatment modalities at each of two Balttmvre cl~ntcs: (a) the Outpatient Department of the Henry Phipps Psychiatry Clinic of the Johns Hopkins Hospital and (h) the CIundry Hospttal Outpatient Department. Approximately I50 patients completed I6 wk of active treatment with reasonable compliance to study procedures, e.g.. regular attendance. taking me&cation as prescribed. completing self-rating measures of symptoms :rnd mood.