II. Answer the questions to the text.

1. What are the sources of extreme stress?

2. How do people react to the stress of unemployment?

3. Is divorce stressful only to the partners involved?

4. What are the four myths about bereavement according to Wortman?

5. What should be taken into account while researching the bereavement?

6. What are the stages of psychological reactions of people to the stressful events?

7. What reactions are frequently seen in survivors of serious accidents?

8. What are the traumatic effects of war on the civilian population?

9. What is the rate of post-traumatic stress?

10. Is 10 percent rate of PTSD considered high or low in a normal community?

3. Choose the facts to prove that:

1. Joblessness is a major source of stress.

2. Separation is “one of the more potent of stressors and one of the more frequent reasons why people seek psychotherapy.”

3. People do not necessarily go through a period of intense grief after the death of a loved one for about a year.

4. Wartime experiences cause intense and disabling combat stress.

Text 10 effectiveness of psychotherapy

What type of therapy is most effective for depression?

The various therapies we have discussed so far all share one characteristic: All are psychotherapies — that is, they use psychological

methods to treat disorders. But is psychotherapy effective? Is it any better than no treatment at all? And if it is, how much better is it?

Does Psychotherapy Work?

One of the first investigators to raise questions about the effectiveness of psychotherapy was the British psychologist Hans Eysenck (1952). After surveying 19 published reports covering more than 7,000 cases, Eysenck concluded that therapy significantly helped about two out of every three people. However, he also concluded that “Roughly two-thirds of a group of neurotic patients will recover or improve to a marked extent within about two years of the onset of their illness whether they are treated by means of psychotherapy or not. ” Eysenck’s conclusion that individual psychotherapy was no more effective in treating neurotic disorders than no therapy at all caused a storm of controversy in the psychological community and stimulated considerable research.

Ironically, an important but often overlooked aspect of the subsequent debate has little to do with the effectiveness of therapy but rather with the effectiveness of no therapy. Many researchers then and today agree with Eysenck that therapy helps about two-thirds of the people who undergo it. More controversial is the question of what happens to people with psychological problems who do not receive formal therapy — is it really true that two-thirds will improve anyway? Bergin and Lambert (1978) questioned the “spontaneous recovery” rate of the control subjects in the studies Eysenck surveyed. They concluded that only about one out of every three people improves without treatment (not the two out of three cited by Eysenck). Since twice as many people improve with formal therapy, therapy is indeed more effective than no treatment at all. Furthermore, these researchers noted that many people who do not receive formal therapy get real therapeutic help from friends, clergy, physicians, and teachers; thus, it is possible that the recovery rate for people who receive no therapeutic help at all is even less than one-third.

Other attempts to study the effectiveness of psychotherapy have averaged the results of a large number of individual studies. The general

consensus among these studies is also that psychotherapy is effective, although its value appears to be related to a number of other factors. For instance, psychotherapy works best for relatively mild compared to more severe disorders and seems to provide the greatest benefits to people who really want to change.

Finally, one very extensive study designed to evaluate the effectiveness of psychotherapy was reported by Consumer Reports (1995). Largely under the direction of psychologist Martin E.P.Seligman, this investigation surveyed 180,000 Consumer Reports subscribers on everything from automobiles to mental health. Approximately 7,000 people from the total sample responded to the mental health section of the questionnaire that assessed satisfaction and improvement in people who had received psychotherapy.

In reviewing the results of this study, Saligman (1995) summarized a few of its most important findings. First, the vast majority of respondents reported significant overall improvement following therapy. Approximately 90 percent of the people who reported feeling very poorer fairly poor prior to therapy reported feeling very good, good, or so-so following therapy. Second, there was no difference in the overall improvement score for people who had received therapy alone and those who had combined psychotherapy with medication. Third, no differences were found between the various forms of psychotherapy. Fourth, no differences in effectiveness were indicated between psychologists, psychiatrists, and social workers, although marriage counselors were seen as less effective. And fifth, people who had received long-term therapy reported more improvement than those who had received short-term therapy. This last result, one of the most striking findings of the study, is illustrated in the Figure below.

The Consumer Reports study lacked the scientific rigor of more traditional investigations designed to assess psychotherapeutic efficacy. For example, it did not use a control group to assess change in people who did not receive therapy. Nevertheless, it provides broad support for the idea that psychotherapy does work.

Duration of therapy and improvement

One ofthe most dramatic results ofthe Consumer Reports (1995) study on the effectiveness of psychotherapy was the strong relationship between reported improvement and the duration of therapy.

Duration of treatinent

Which Type of Therapy Is Best for Which Disorder?

We have seen that researchers generally agree that psychotherapy is usually effective. This raises a second question: Is any particular form of psychotherapy more effective that the others? Is behavior therapy, for example, more effective than insight therapy? In general, the answer seems to be “not much. ” Most of the benefit of treatment seems to come from being in some kind of therapy, regardless of the particular type.

The various forms of psychotherapy are based on different views of the causes of mental disorders, and at least on the surface, they approach the treatment of mental disorders very differently. So how can they all be equally effective? To answer this question, some psychologists have focused their attention on what the various forms of psychotherapy have in common, rather than emphasizing their differences.

First, all forms of psychotherapy provide people with an explanation for their problems.

Along with the explanation often comes a new perspective, providing the people with specific actions to help them cope more effectively. Second, most forms of psychotherapy offer hope. Because most people who seek therapy have low self-esteem and feel demoralized and depressed, hope and the expectation for improvement increases their feelings of self-worth. And third, all major types of psychotherapy engage the client in a therapeutic alliance with the therapist. Despite differing therapeutic approaches, effective therapists are warm, empathetic, and caring people who understand the importance of establishing a strong emotional bond with their clients built on mutual respect and understanding. Together, these nonspecific factors, which are common to all forms of psychotherapy, appear at least in part to account for why most people who receive therapy show some benefits compared to those who receive no therapeutic help at all.

Still, some kinds of psychotherapy seem to be particularly appropriate for certain people and for certain types of problems. Insight therapy, for example, seems to be best suited to people seeking profound self-understanding, relief of inner conflict and anxiety, or better relationships with others. Behavior therapy is apparently most appropriate for treating specific anxieties or other well-defined behavioral problems such as sexual dysfunctions. Family therapy is generally more effective than individual counseling for the treatment of drug abuse. Cognitive therapies have been shown to be effective treatments for depression and seem to be a promising treatment for anxiety disorders as well.

To assist psychologists in selecting the most effective treatment methods, the Clinical Division of the American Psychological Association (1995) appointed the Task Force on Psychological Intervention Guidelines to review the scientific literature and develop a fist of treatments shown to be effective through controlled research. This fist of empirically supported therapies, or ESTs, is designed to help therapists decide on the most appropriate therapy for a specific disorder. Since its pubheation, many psychologists have advanced the position that these therapies should be emphasized over those with less or no empirical support, particularly in training programs for clinical psychologists. The race, culture, ethnic background, and gender of both client and therapist can also influence which therapy is effective.