Does Psychotherapy Really Work - Assignment Example

Does psychotherapy really work? Psychotherapy involves a relationship between client and therapist in which the process of analyzing a problem and coming to a solution is explored. Evaluating whether or not psychotherapy works is a very complex task. A major reason for this is because it is difficult to determine when in fact the therapeutic process ends. Psychotherapy can be a short term process lasting a few sessions or it can extend for more than a year for some situations. Research to evaluate the long term process is harder to carry out than for the short term process. Another challenge in evaluating the effectiveness of psychotherapy lies in the fact that there are so many types of psychotherapy existing and it is usually difficult to separate out the effects of the psychotherapy from other factors that are operating and affecting the client’s life at any one time. Further many clients and therapists are not willing to discuss their relationship and the process for fear of breaking confidentiality and for self-protection. Despite the challenges, the general consensus is that psychotherapy is beneficial to some extent. It has perhaps not been reported that psychotherapy harmed a patient. Depressive disorders though usually non-fatal have many consequences on the life of the patient. Patients suffering with forms of depression have been known to function less effectively in their work, their families, marriage and relationships, parenthood and social contacts. Depressive disorders are also serious because they of the high prevalence and recurrence and the chronic nature of the disorders. Molenaar et al (2007) have added their study to the body of knowledge of whether combining psychotherapy with pharmacotherapy is a more effective treatment to relieve the depressive symptoms and also to increase social functioning. As stated by these authors, “Psychotherapy targets three aspects of depression: symptoms of depression, (psycho) social functioning, and personality”. Of a sample of 167 patients they treated 84 with pharmacotherapy only and 84 with combined pharmacotherapy and psychotherapy. The results showed that only some aspects of the depressive disorders were improved with the combination treatment. The interpersonal roles such as home/cohabitating role, citizen roles, and professional roles showed more improvement with the co-treatment. Aspects such as leisure time, relationships with parents, living with partners, social role and housekeeping showed no difference in treatments. One of the points made by the authors about these results is that psychotherapy pays attention t o social interaction; it is no surprise that the interpersonal roles are the ones that showed a difference in treatment. Interesting to note about this study also is that although there was no significant difference in treatment for aspects such as leisure time etc, there was improvement in these in both treatments. So that one cannot say that the psychotherapy was not effective. It must have had some effect on the improvement of the clients. I also agree with the authors on two important points. One is that the psychotherapy was only given for sixteen weeks. It is possible that longer treatments may have provided different results. Clients are usually in therapy for longer than sixteen weeks for there to be positive results. The other point is that the results were measured immediately after the study, but a more longitudinal study might also provide different results. Effects of psychotherapy are usually not seen immediately. The common treatment for depression is through medication. However one of the issues with chemical treatment of depression is that patients do not adhere to the treatment for long enough periods of time. Psychotherapy has been found to have the additional benefit of prolonging adherence to treatment. Combining medication with psychotherapy improves the depressive state. Pampellona et al (2004) concluded that “psychological treatment combined with antidepressant therapy is associated with a higher improvement rate than drug treatment alone. In longer therapies, the addition of psychotherapy helps to keep patients in treatment”. They therefore reviewed randomized clinical trials (RCTs) to investigate the effect of combining psychotherapy with pharmacotherapy on completion of treatment. They reviewed a total of eleven studies involving 930 participants who received pharmacotherapy alone and 910 who received combined treatment. As with previous studies they found that adding psychotherapy to the treatment reduced the dropout rates. A significant aspect of this analysis was that the rate of dropout decreased the longer the study was conducted. Although the analysis indicates the effect of psychotherapy on drop- out rate for patients; it would be interesting to be able to identify the effects of the psychotherapy alone. Studies conducted with two variables, i.e. psychotherapy and pharmacotherapy separately would yield more definitive evidence of the use of psychotherapy. The results from the length of study indicating that the dropout rate was lower the longer the study was in existence, again points to the fact that psychotherapy must be an on-going process and is not effective in just a few sessions. The authors raised another point for consideration- there was still some dropout from treatment and so it is necessary to explore the possibility of other interventions for those who did not benefit enough from either the pharmacotherapy or the combined therapy. Despite the prevalence of depression among elderly people, the number of them seeking mental health support is small due to stigma attached to mental health and the inconvenience of getting to sessions. Usual treatment for depression in elderly has been pharamacotherapy. However Scogin et al (2001) report that there is a fraction of patients who do not respond positively to the medication. These authors therefore address alternative means to address these residual effects of depression not treated by the medication such as their cognitive functioning, relationships and their health care. One of the suggested alternatives is psychotherapy. The authors quote studies that show psychotherapy as an effective treatment for geriatric depression. But they also indicate that psychotherapy is useful in combination with medication. They state that “Using psychosocial treatments as adjuncts to antidepressant therapy is an appealing option because psychotherapy often addresses issues that may be hindering a person’s improvement which medication is unable to specifically target. Psychosocial treatments can provide information about depressive illness, additional coping strategies to implement in facing stressors, and means for combating demoralization and feelings of hopelessness accompanying depression”. In particular cognitive-behavioral therapy has been found to be a very effective therapy for elderly to manage the unchangeable negative events that they experience at this age. In this article the focus on cognitive-behavioral therapy is of interest. The idea of the elderly using this form of psychotherapy may not be a common one, as it is often thought that once a person reaches this stage of development the intellectual functioning slows down. The vast amount of research presented in this article on the positive outcomes on the use of cognitive-behavioral therapy with elderly is a contradiction and a hope. The discussion of the many ways in which depression has a residual effect especially on the elderly was also very enlightening and useful information for all involved in geriatric care. While psychotherapy is seen to be helpful generally, Miller (1999) presents a situation where he believes that psychotherapy alone is not enough. He explores the mental health needs of refugees and suggests that conventional psychotherapy is not sufficient to address some aspects of war and exile-related distress. The reasons presented that contribute to the ineffectiveness of psychotherapy alone have to do with the types of distress suffered, the pervasiveness of the psychological distress and the cultural gap that causes the reluctance of many refugees to use psychotherapy. Refugees suffer from distress that is present or comes from the daily experience of being in a different country or living under different circumstances. Miller describes some of these distresses as “as the loss of ones community and social network, the loss of important life projects, changes in socioeconomic status and related concerns about economic survival, the loss of meaningful structure and activity in daily life, and the loss of meaningful social roles”. It is very difficult for refugees to access local psychotherapy services, not just because of the difficulty with a different language sometimes, but also lack of understanding of the therapist of the refugee’s cultural practices and beliefs (usually a clash between non-western and western cultures). The article suggests that a more community-based intervention works more effectively with such a population. Success has been greater when psychotherapy has been combined with collaboration with spiritual healers, and other lay persons of the same culture. As Miller states, “Psychotherapy can play a potentially powerful role in the healing process of those refugees who have access to it, when it is conducted in culturally sensitive ways that respect the particular belief systems and rituals of healing that people bring with them into exile”. Cultural beliefs and experiences are an important aspect for psychotherapy to work effectively. Emotional safety and trust are important aspects of effective psychotherapy. Additionally, it is an important point raised by the author that for this population it is not only the early life experiences, but the present day effects of the exile that may be affecting the client more. Leichsenring and Rabung (2008) focused on the long-term psychotherapy and its effectiveness. They agree that there is enough evidence to show the effectiveness of short-term psychotherapy for acute distress. However, they suggest that there is evidence to suggest that short term psychotherapy is not as effective with some patients for multiple or chronic mental disorders and personality disorders. In order to fill the void that they thought was lacking in meta-analyses of long term psychotherapy they undertook this analysis that looked at studies of psychotherapy that lasted at least a year or for fifty sessions. They analyzed 23 studies involving 1053 participants. They found that the long term psychotherapy was significantly better than shorter term psychotherapy in patients with personality disorders, multiple mental disorders and chronic mental disorders. The long term psychotherapy was yielded large effects in the overall outcome of the therapy, the target problems and personality functioning. This study broadened the data and evidence for psychotherapy not only by examining long term psychotherapy but also by including an examination of other disorders than depression. This study examined the effects of psychotherapy on personality disorders, chronic mental disorders, multiple mental disorders and anxiety, in addition to depression. So that it adds greatly to the discussion of benefits of psychotherapy. In addition the paper analyzed studies that compared the effects of long term psychotherapy on the usual short term psychotherapies such as cognitive-behavioral therapy, dialectical-behavioral therapy, and family therapy. The paper therefore not only supports the evidence for the use of these regular forms of psychotherapy, but also adds the benefits of long term therapy. In conclusion, psychotherapy is proven to be very beneficial and effective to most patients. Most of the literature seems to be focused on the use of psychotherapy in treating depressive disorders. However there have been reports of other types of disorders benefiting from psychotherapy as reported by Leichsenring and Rabung (2008). The effectiveness seems to be higher when combined with other interventions, for example with pharmacotherapy in the case of depression. Much more research is needed to add to the evidence of the effectiveness of psychotherapy in these other disorders References. Leichsenring, F. & Rabung, S. (2008). The effectiveness of long-term psychodynamic psychotherapy. A meta-analysis. The Journal of the American Medical Association. 300 (13), 1551-1565 Miller, K.E. (1999). Rethinking a Familiar Model: Psychotherapy and the Mental Health of Refugees. Journal of Contemporary Psychotherapy 29 (4), 283-306 Molenaar, P.J., Dekker, J., Van, R., Hendriksen, M., Vink, A. & Schoevers, R.A. (2007). Does adding psychotherapy to pharmacotherapy improve social functioning in the treatment of outpatient depression? Depression and Anxiety 24, 553–562 Pampallona, S., Paola Bollini, P., Tibaldi, G., Kupelnick, B. & Munizza, C. (2004) Combined Pharmacotherapy and Psychological Treatment for Depression. Arch Gen Psychiatry. 61, 714-719 Scogin, F., Shackelford, J., Rohen, N., Stump, J., Floyd, M., McKendree-Smith, N., &Christine Jamison, C. (2001). Residual Geriatric Depression Symptoms: A Place for Psychotherapy. Journal of Clinical Geropsychology, 7 (4), 271-283 Read More