Monitor on Psychology - November 2011 - (Page 5)
Advancing health with psychotherapy
BY DR. MELBA J.T. VASQUEZ • APA PRESIDENT
s this month’s cover story illustrates, APA is working to ensure that health-care reform increases all patients’ access to mental health services. A key part of achieving that goal is ensuring that today’s health-care system embraces the use of evidence-based psychotherapies. There is a large body of evidence indicating that psychotherapy should be the goto treatment for nonpsychotic conditions. Research has shown, for example, that when psychotherapy is administered by appropriately trained psychologists, it is highly effective, relatively safe and saves health-care dollars in the long run (Barlow, 2010; Baldwin, et al., 2009; TADS, 2007; Wampold, 2010). The best research evidence shows that psychotherapy is efficacious for a broad range of disorders, symptoms and problems across the age span (Chambless et al., 1998; Knight, 2004; Lambert & Archer, 2006, Wampold, 2001; Weisz & Jensen, 2001). For many disorders, including anxiety and depression, a variety of psychotherapies have been shown to benefit patients in rigorous clinical trials (Beutler, et al., 2003; Lambert & Ogles, 2004; Shedler, 2010; Wampold, 2001; Weisz et al., 2004). Research has also shown that psychotherapy is as effective as pharmacological treatment for many mental disorders, without the adverse side effects or the expense of many medical treatments (Barlow, Gorman, Shear, & Woods, 2000; Hollon, Stewart, & Strunk, 2006; Imel, McKay, Malterer, & Wampold, 2008; Mitte, 2005; Mitte, Noack, Steil, & Hautzinger, 2005; Robinson, Berman, & Neimeyer, 1990). Through psychotherapy, clients/patients acquire coping skills and it appears that those who commit to treatment generally either do not relapse or continue to improve after treatment ends (Hollon, Stewart, & Strunk, 2006). Successful psychotherapy depends in part on the therapeutic alliance between therapist and client/patient. That partnership requires a bond between the psychologist and the client/patient, agreement about the goals and tasks of the treatment, belief in the treatment and a clear understanding of the client’s/patient’s problems, based on sound psychological foundations (Cuijpers, et al., 2008; Lambert, 2004; Shirk & Karver, 2003; Karver et al., 2006; Norcross, 2002; Wampold, 2007). Research has also established that standard evidence-based treatments and culturally adapted interventions are effective with racial and ethnic minorities, as well as for those from a variety of
N OV E M B E R 2 0 1 1 • M O N I TO R O N P S YC H O L O G Y
socioeconomic backgrounds. The impact of culture or social class may be most important during therapeutic engagement, rather than on the outcome of those who completed treatment. Thus, psychologists may need to adapt a treatment’s content, language or approach to engage and retain clients. It is especially important that the client’s beliefs and values about etiology, symptoms, course, consequences and treatment options are considered (Benish, Quintana, & Wampold, 2011; Bernal & Scharron del Rio, 2001; Miranda et al., 2005; Miranda et al., 2006; Smith, Domenech Rodriguez & Bernal, 2011; Whaley and Davis 2007). Psychotherapy is also effective for a variety of disabilities over the life span, including cognitive, intellectual, physical, visual, auditory, and psychological impairments (Glickman, 2009). Research also supports the beneficial effects of psychotherapy as a means of improving mood and reducing depression among individuals with acute and chronic health conditions (e.g., arthritis, cancer, HIV/AIDS) (Fisch, 2004; Himelhoch et al., 2007; Lin et al., 2003). Despite the high effectiveness of psychotherapy, we still need to know more about how psychotherapy works. Psychotherapist effects and what qualities and actions make some more effective than others are also important issues. While acknowledging the importance and value of clinical treatment, Kazdin & Blasé (2011) are concerned that those in minority groups, particularly those in rural areas, lower income populations, elderly patients and young patients, may not have access to services. They point to other models of service delivery, including telepsychology, as part of the solution. APA, the Association of State and Provincial Psychology Boards and the APA Insurance Trust are working together to develop telepsychology guidelines, which will help support efforts to provide services more broadly. The integration of science and practice will influence the future of psychotherapy. Toward that end, APA is developing treatment guidelines so that the best and latest findings are easily available to practitioners. In addition, APA’s Council of Representatives will soon review, and I hope endorse, an official statement by APA on psychotherapy effectiveness. APA is continuing its work to ensure psychologists’ evidence-based treatment is front and center as the nation puts its new healthcare system in place. n For references in this article, click here.
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