Eysencks Review of the Research Literature on Effectiveness of Psychotherapy Found Quizlet
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[Classics Editor's note: The one footnote in this article has been enclosed in curly brackets, to distinguish information technology from the reference notes, which are enclosed in square brackets, as in the original.]
The recommendation of the Committee on Grooming in Clinical Psychology of the American Psychological Association regarding the training of clinical psychologists in the field of psychotherapy has been criticized past the writer in a series of papers [10, 11, 12]. Of the arguments presented in favor of the policy advocated by the Commission, the most denoting one is mayhap that which refers to the social need for the skills possessed by the psychotherapist. In view of the importance of the bug involved, it seemed worth while to examine the evidence relating to the actual effects of psychotherapy, in an endeavor to seek clarification on a point of fact.
Landis realized quite clearly that in lodge to evaluate the effectiveness of whatsoever form of therapy, data from a command grouping of nontreated patients would be required in club to compare the effects of therapy with the spontaneous remission rate. In the absence of annihilation better, he used the amelioration charge per unit in state mental hospitals for patients diagnosed under the heading of "neuroses." As he points out:
There are several objections to the use of the consolidated amelioration rate . . . of the . . . country hospitals . . . as a base rate for spontaneous recovery. The fact that psychoneurotic cases are not usually committed to land hospitals unless in a very bad condition; the relatively small number of voluntary patients in the group; the fact that such patients do go some degree of psychotherapy especially in the reception hospitals; and the probably quite different economical, educational, and social status of the State Hospital group compared to the patients reported from each of the other hospitals - all contend confronting the acceptance of [this] figure . . . as a truly satisfactory base line, but in the absence of whatsoever other better figure this must serve [26, p. 168].
Really the various figures quoted by Landis agree very well. The pct of neurotic patients discharged annually as recovered or improved from New York state hospitals is 70 (for the years 1925-1934); for the United States as a whole information technology is 68 (for the years 1926 to 1933). The percentage of neurotics discharged as recovered or improved inside one year of admission is 66 for the United States (1933) and 68 for New York (1914). The consolidated amelioration rate of New York state hospitals, 1917-1934, is 72 per cent. Every bit this is the figure called by Landis, nosotros may accept it in preference to the other very similar ones quoted. Past and big, we may thus say that of astringent neurotics receiving in the master custodial care, and very little if any psychotherapy, over two-thirds recovered or improved to a considerable extent. "Although this is not, strictly speaking, a basic figure for 'spontaneous' recovery, notwithstanding any therapeutic method must evidence an appreciably greater size than this to be seriously considered" [26, p. 160].
Another gauge of the required "base of operations line" is provided by Denker:
[p. 320] Five hundred consecutive disability claims due to psychoneurosis, treated past general practitioners throughout the country, and non by accredited specialists or sanatoria, were reviewed. All types of neurosis were included, and no attempt made to differentiate the neurasthenic, feet, compulsive, hysteric, or other states, but the greatest care was taken to eliminate the truthful psychotic or organic lesions which in the early states of illness so often simulate neurosis. These cases were taken consecutively from the files of the Equitable Life Balls Society of the Usa, were from all parts of the country, and all had been sick of a neurosis for at least 3 months before claims were submitted. They, therefore, could be fairly chosen "severe," since they had been totally disabled for at least a three months' period, and rendered unable to carry on with any "occupation for remuneration or profit" for at least that time [nine, p. 2164].
These patients were regularly seen and treated by their ain physicians with sedatives, tonics, suggestion, and reassurance, but in no case was any attempt made at anything but this most superficial type of "psychotherapy" which has always been the stock-in-merchandise of the general practitioner. Repeated statements, every three months or and so by their physicians, too as independent investigations by the insurance visitor, confirmed the fact that these people actually were non engaged in productive work during the period of their illness. During their disablement, these cases received disability benefits. Equally Denker points out, "It is appreciated that this fact of inability income may have actually prolonged the total period of inability and acted as a barrier to incentive for recovery. One would, therefore, non expect the therapeutic results in such a grouping of cases to be as favorable as in other groups where the economic cistron might act as an of import spur in helping the sick patient adjust to his neurotic disharmonize and illness" [nine, p. 2165].
The cases were all followed upward for at to the lowest degree a five-year period, and frequently as long as 10 years afterward the period of disability had begun. The criteria of "recovery" used by Denker were as follows: (a) return to work, and ability to carry on well in economic adjustments for at least a five-yr period; (b) complaint of no farther or very slight difficulties; (c) making of successful social adjustments. Using these criteria, which are very similar to those usually used by psychiatrists, Denker constitute that 45 per cent of the patients recovered after ane yr, some other 27 per cent after two years, making 72 per cent in all. Another 10 per cent, 5 per cent, and four per cent recovered during the third, fourth, and fifth years, respectively, making a total of 90 per cent recoveries after five years.
This sample contrasts in many ways with that used past Landis. The cases on which Denker reports were probably non quite equally severe equally those summarized by Landis; they were all voluntary, nonhospitalized patients, and came from a much college socioeconomic stratum. The bulk of Denker's patients were clerical workers, executives, teachers, and professional men. In spite of these differences, the recovery figures for the two samples are almost identical. The most suitable figure to cull from those given by Denker is probably that for the ii-year recovery rate, as follow-up studies seldom go beyond two years and the higher figures for three-, 4-, and five-year follow-upwardly would overestimate the efficiency of this "base line" procedure. Using, therefore, the two-twelvemonth recovery figure of 72 per cent, nosotros find that Denker'due south figure agrees exactly with that given by Landis. We may, therefore, conclude with some conviction that our estimate of some two-thirds of astringent neurotics showing recovery or considerable improvement without the benefit of systematic psychotherapy is not likely to be very far out.
A number of studies take been excluded considering of such factors equally excessive inadequacy of follow-up, partial duplication of cases with others included in our table, failure to betoken blazon of treatment used, and other reasons which made the results useless from our bespeak of view. Papers thus rejected are those by Thorley & Craske [37], Bennett and Semrad [p. 322] [2], H. I. Harris [19], Hardcastle [17], A. Harris [18], Jacobson and Wright [21], Friess and Nelson [fourteen], Comroe [v], Wenger [38], Orbison [33], Coon and Raymond [six], Denker [8], and Bond and Braceland [3]. Their inclusion would not accept altered our conclusions to any considerable degree, although, as Miles et al. point out: "When the various studies are compared in terms of thoroughness, careful planning, strictness of criteria and objectivity, there is often an inverse correlation between these factors and the percentage of successful results reported" [31, p. 88].
Certain difficulties have arisen from the inability of some writers to make their column figures concord with their totals, or to summate percentages accurately. Again, the writer has exercised his judgment equally to which figures to have. In certain cases, writers accept given figures of cases where there was a recurrence of the disorder after apparent cure or comeback, without indicating how many patients were afflicted in these two groups respectively. All recurrences of this kind accept been subtracted from the "cured" and "improved" totals, taking one-half from each. The total number of cases involved in all these adjustments is quite small. Some other investigator making all decisions exactly in the opposite direction to the present author'due south would hardly modify the last per centum figures by more than 1 or two per cent.
We may now turn to the figures as presented. Patients treated by means of psychoanalysis meliorate to the extent of 44 per cent; patients treated eclectically meliorate to the extent of 64 per cent; patients treated merely custodially or past general practitioners improve to the extent of 72 per cent. In that location thus appears to exist an changed correlation between recovery and psychotherapy; the more psychotherapy, the smaller the recovery rate. This decision requires certain qualifications.
In our tabulation of psychoanalytic results, nosotros take classed those who stopped treatment together with those not improved. This appears to be reasonable; a patient who fails to terminate his handling, and is non improved, is surely a therapeutic failure. The same dominion has been followed with the data summarized under "eclectic" handling, except when the patient who did not finish handling was definitely classified as "improved" past the therapist. However, in view of the peculiarities of Freudian procedures it may appear to some readers to be more just to class those cases separately, and deal only with the percentage of completed treatments which are successful. Approximately ane-third of the psychoanalytic patients listed broke off treatment, then that the percentage of successful treatments of patients who finished their class must be put at approximately 66 per cent. It would appear, then, that when we discount the gamble the patient runs of stopping handling birthday, his chances of improvement under psychoanalysis are approximately equal to his chances of improvement under eclectic treatment, and slightly worse than his chances under a full general practitioner or custodial handling.
Two further points require clarification: (a) Are patients in our "command" groups (Landis and Denker) as seriously ill as those in our "experimental" groups? (b) Are standards of recovery maybe less stringent in our "control" than in our "experimental" groups? It is difficult to answer these questions definitely, in view of the great divergence of stance between psychiatrists. From a shut scrutiny of the literature information technology appears that the "control" patients were probably at least equally seriously ill as the "experimental" patients, and perchance more so. As regards standards of recovery, those in Denker's study are as stringent as nearly of those used by psychoanalysts and eclectic psychiatrists, but those used past the Country Hospitals whose figures Landis quotes are very probably more lenient. In the absence of agreed standards of severity of illness, or of extent of recovery, information technology is non possible to go further.
In general, certain conclusions are possible from these data. They fail to bear witness that psychotherapy, Freudian or otherwise, facilitates the recovery of neurotic patients. They show that roughly two-thirds of a group of neurotic patients will recover or better to a marked extent within about two years of the onset of their illness, whether they are treated by means of psychotherapy or not. This figure appears to exist remarkably stable from one investigation to another, regardless of type of patient treated, standard of recovery employed, or method of [p. 323] therapy used. From the bespeak of view of the neurotic, these figures are encouraging; from the point of view of the psychotherapist, they tin hardly be called very favorable to his claims.
The figures quoted do not necessarily disprove the possibility of therapeutic effectiveness. At that place are obvious shortcomings in any actuarial comparison and these shortcomings are particularly serious when at that place is then little agreement among psychiatrists relating even to the most fundamental concepts and definitions. Definite proof would crave a special investigation, carefully planned and methodologically more acceptable than these ad hoc comparisons. But even the much more pocket-size conclusions that the figures fail to evidence any favorable furnishings of psychotherapy should requite break to those who would wish to give an important part in the preparation of clinical psychologists to a skill the existence and effectiveness of which is all the same unsupported by any scientifically acceptable evidence.
These results and conclusions will no doubt contradict the stiff feeling of usefulness and therapeutic success which many psychiatrists and clinical psychologists hold. While it is true that subjective feelings of this type have no place in science, they are likely to prevent an easy acceptance of the general argument presented here. This contradiction between objective fact and subjective certainty has been remarked on in other connections past Kelly and Fiske, who found that "One aspect of our findings is most disconcerting to us: the inverse relationship between the conviction of staff members at the time of making a prediction and the measured validity of that prediction. Why is is, for case, that our staff members tended to make their all-time predictions at a fourth dimension when they subjectively felt relatively unacquainted with the candidate, when they had constructed no systematic picture show of his personality structure? Or conversely, why is information technology that with increasing confidence in clinical judgment . . . we notice decreasing validities of predictions?" [23, p. 406].
In the absence of agreement between fact and belief, at that place is urgent need for a decrease in the forcefulness of belief, and for an increment in the number of facts available. Until such facts as may be discovered in a process of rigorous analysis support the prevalent belief in therapeutic effectiveness of psychological handling, it seems premature to insist on the inclusion of preparation in such treatment in the curriculum of the clinical psychologist.
Received January 23, 1952 [sic].
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