Intervention Defined

  • Psychological Intervention: A method of inducing change in a person's behavior, thoughts or feelings. Intervention in the context of a professional relationship (client-patient).
  • In referring to treatment the terms intervention and psychotherapy have been used interchangeably.
  • Woolberg (1967): symptoms and treatment, promoting positive growth (type of medical def.)
  • Rotter (1971) and Frank (1982) pose different definitions using terms like—interaction between a healer and sufferer, reliving of distress & disability, personal growth.

Does Psychotherapy Help?

  • Need to address both the efficacy of a treatment and the effectiveness of a treatment.
  • Efficacy Studies: Average person receiving treatment is demonstrated to be less dysfunctional than the person not receiving treatment.

o Take place in a research lab/university clinic (focus on internal validity)

  • Effectiveness Studies: Focus on external validity and the representativeness of the treatment in the “real-world”. May not include control groups or random assignment; focus is on whether a client receiving treatment as it is typically administered reports significant relief/benefits.

Evidence Based Treatment and Evidence Based Practice

  • Focus on whether clinical evidence-based treatments (psychotherapy vs. no treatment) are more effective than other therapies.
  • Evidence-Based Treatment (EBT): Refers to treatments/interventions that have produced significant changes in clients/patients in controlled trials.

o Treatment vs. control group (comes solely from controlled clinical trials)

  • Evidence-Based Practice (EBP): Broader practice that includes treatment informed by various sources.
  • Society of Clinical Psychology (sub-division of the APA) developed specific criteria to evaluation different approaches to therapy/intervention treatments.
  • Referred to as “evidence-based treatments” these criteria addresses whether certain therapy mechanisms may be useful in reducing mental health symptoms.

Features Common to Many Therapies

  • Supportive factors—positive relationship, trust lay the groundwork for change in person's beliefs & attitudes (learning factors)     lead to behavioral change (action factors—mastery, risk taking.

Relationship/Therapeutic Alliance & The Expert Role

  • Client-therapist relationship is important for successful psychotherapy (accepting, non- judgmental, insightful and professional)
  • Therapists are also expected to be competent as a result of training, knowledge and experience.

Building Competency/Mastery

  • Help the client be a more competent human, greater satisfaction. Therapist may work with client to help them learn new things or alter their faulty ways of thinking.
  • It can be a learning experience; develop feelings of self-efficacy in the individual.
  • Mastery—confident, expect to do well and feel good about themselves; will function better.

Non-Specific Factors

  • Faith, Hope or expectations for increased competence; individuals come to therapy believing that it will help promote mental health.
  • The expectations of the client are vital to the therapy process.

Nature of Specific Therapeutic Variables

The Patient or Client

The Degree of the Patient's Distress

  • Therapists generalization is that people that need therapy the least are ones that will benefit most from it.
  • Research data on this has been inconsistent—greater individual distress^ greater improvement, vice-versa and curvilinear (of finding poorer outcomes).


  • Communicating with a patient about past experiences, insight & introspection requires some level of intelligence.
  • Behavioral therapy has been successfully used with individuals with different intelligence levels.


  • Young adults are viewed as being better for therapy than older adults (more flexible)
  • Considering the specific characteristics of the patient and not age alone is important.


  • In Psychotherapy most of the work occurs outside therapy though homework and between therapy sessions. Need to engage in anxiety provoking “new behaviors” (i.e. Albert Ellis)
  • Psychotherapy is a voluntary process & can't be forced on a patient
  • Varied findings on how to best assess client motivation.

Openness and Gender

  • Patients that willing to be open to psychotherapy and not wanting immediate medical treatment are easier to work with. More open patient better long-term outcomes.
  • Biological sex is not directly linked to treatment outcomes; but therapist gender may be important to consider in psychotherapy (e.g. rape victims and male vs. female therapist).

Race, Ethnicity & Social Class

  • Many therapeutic techniques have been designed for white middle and upper class patients, and not for minorities.
  • Very little research indicating that social class, values, background, and ethnic minorities receive poorer outcomes.
  • But when social class and values of the patient and the therapist differ extensively; there needs to be some level of cultural sensitivity.

The Therapist

Age, Sex & Ethnicity and Personality

  • Therapist's age is not related to outcome; different genders do not produce better outcomes that patient-therapist similarity for ethnicity does not play that huge of a role.
  • Therapist personality does effect treatment outcomes, but the research in the area is lacking.

o Mature, sensitive, tolerant, free of bias, intelligent, creative, personally secure...

Empathy, Warmth and Genuineness

  • Commitment & interest in the patient. The focus on empathy, warmth and genuineness grew out of Carl Rogers Client-Centered Therapy.

o Necessary & sufficient variables for therapeutic change.

o Only modest relation between these 3 variables and outcomes.

  • These three features can be viewed as indicators of the quality of therapeutic alliance.

Emotional Well-Being

  • Therapists need to be aware of their emotional state; so self-awareness is an important aspect.
  • Therapy is not a place for gratifying the therapist's emotional needs.

Experience and Professional Identification

  • No consistent relationship between therapist experience and outcome; paraprofessional therapy outcome sometimes exceed even those conducted by trained psychotherapists.
  • Psychiatrists often sought to prevent psychologists from conducting therapy without psychiatric supervision because they were concerned about the medical aspect of treating patients.

Course of Clinical Intervention: Typical Sequence

Initial Contact

Often unknowing what to expect, may be anxious or suspicious.

To patients or parents that contact the clinic, they are first informed of what the clinic is about & what type of help will be provided.

  • After the other steps in the sequence will be covered—professional staff, qualifications, fees...


  • Variety of assessments are made but there is often an intake interview (to gain case history)
  • Consultations with other specialties are also done—neurological workup, medical exam.
  • Information is compiled to arrive at a label; will assist with identifying therapy approaches (assessment is an ongoing process).

The Goals of Treatment

  • Negotiation of goals of treatment or therapist & client discuss how patient's problem will be


  • In treating a child, they may not know what therapy is or why they are being asked to go to therapy. Parents legally have a right to know all information therapist communicates to the child (this makes confidentiality hard).

Implementing Treatment

  • Following goal establishment specific therapy forms/treatment is identified (ex: client-centered, cognitive, behavioral)
  • Treatment needs to be described to client in detail (in terms of length and what is expected of them).

Termination, Evaluation and Follow-Up

  • Once therapist begins to gauge that client is able to handle their problems themselves, termination discussion begins.
  • Client's feelings and attitudes towards termination should be assessed.
  • Sometimes termination is abrupt or forced (in which case referral is done).

Stages of Change

  • Refers to a series of stages that represents a client's readiness of change in psychotherapy.
  1. Pre-Contemplation: Client has no intention of changing his/her behavior in the near future. Come in as a result of outside pressures.
  2. Contemplation: Client is aware that a problem exists but has not begun steps to make changes.
  3. Preparation: Client intends to make a change in the near future.
  4. Action: Clients are changing maladaptive behavior, emotions or environment
  5. Maintenance: Client is focused on preventing relapses and continuing the action stage.
  6. Termination: Client has made necessary changes (sort of like a habit), no concern for relapse.
  • Therapists need to recognize that not all individuals are ready to make change; the action stage is where administered treatment is most likely to have an effect.
  • As certain processes match certain stages, therapists should only use interventions specific to that stage.

Issues in Psychotherapy Research

  • Hans Eysenck attacked the efficacy of psychotherapy, but many have criticized his work for its validity as he did not match participants in the treatment vs. control groups.
  • Studies that seek to understand the efficacy of psychotherapy use an experimental design with a control group and a treatment/experimental group.
  • Waiting List Control Group: Treatment is delayed until after study is completed
  • Attention Only Control Group: Patient meets regularly with a therapist, but there is no treatment

o Matched on age, race, gender, severity of symptoms (factors that could influence outcome)

  • Patient Functioning: Symptoms of psychopathology

Research Considerations

  1. What is the sample? —ex: voluntary or coerced patients, were the therapist's behaviors or psychoanalysts
  2. What relevant variables were controlled? Ex: --control vs. treatment group variables.
  3. What were the outcome measures? —were outcomes measured identically for all patients or were they tailored? Was a single measure used or were there multiple measures?
  4. What was the overall nature of the study? (experiments, case studies, correlational studies.)

Comparative Studies

Studies comparing efficacy techniques and not only looking at outcomes.

The Temple University Study

  • The study comparing 90 outpatients with neurotic symptoms concluded that patients that received Behavior Therapy (BT) did the best in the long-term
  • Those who obtained Psychoanalytic therapy (PT) improved equally as well as the BT Group; but those in the BT Group showed slightly more improvement; flexibility & versatility of Behavioral therapy.


  • A method of research that complies all studies relevant to a topic or question and combines the results statistically.
  • Effect size: The size of the treatment effect

Mean of experimental group - Mean of control group

Effect size = -------------------------

Standard deviation

Process Research

  • Refers to research that investigates the specific events that occur in the course of the interaction between therapist & patient. (Rogerians)
  • Some therapy processes have been shown to relate to treatment outcome.
  • Therapy investigators either looked at process research or outcome research.
  • Process therapy researchers felt that the process that was used during therapy related to the outcome that occurred (film/tape therapy sessions).
  • Factors that influence relationship between therapeutic process and outcome

o Client-therapist communication

o Therapist competence and adhere to treatment protocol

o Therapist use of guidance and advice not related to outcome

Recent Trends

Focus of Psychotherapy Research

  • Specific factors (motivation, SES) that are related to higher efficacy and effectiveness
  • What aspects of specific therapy mechanisms (e.g. CBT therapy) are most important for the therapy outcome.
  • Focus on types of therapies that work for each specific diagnosis.

Practice Guidelines

  • Clinical psychologists are being held accountable for the services they provide by insurance companies.
  • Several professional organizations have developed practice guidelines that recommend specific forms of treatment/intervention for specific psychological problems.

Manualized Treatment

  • Treatment manuals were originally developed to ensure standardized treatment across patients.
  • Manualized treatment has been criticized for undermining clinical judgement, treatment not being tailored to patients with comorbid conditions.
  • Manualized treatment is more focused and, easier to teach and supervise and more focused from the patient's perspective and are far more appealing to managed care companies.
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