3.5: Integrative and Emerging Therapies

Learning Objectives

• Describe major conclusions about the common factors that produce effective results with psychotherapy and describe several forms of integrative or eclectic therapies
• Give examples of several relatively new or emerging forms of psychotherapy

Evaluating Various Forms of Psychotherapy and Common Factors

Given that there are so many different types of therapies available today, how does a client decide what type of therapist to approach? One consideration is that some forms of therapy were created by a particular psychologist or psychiatrist and thus may be more restricted by where the psychologist (and others he or she trains) live such as their country or region within a country. For instance, interpersonal psychotherapy (IPT), which focuses on coping with or improving relationships, dealing with grief, life transitions such as retirement or divorce, and resolving conflict with others, has been found to be effective in treating depression and other mood disorders. However, most practitioners of interpersonal psychotherapy (IPT) are on the east coast of the United States since this form of therapy began there and many who have been trained in it live in that part of the country. This limited access may change over time as more clinicians are trained and with increased use of online training programs. Another consideration is the effectiveness of the therapy for the mental disorder the client struggles with. Is one technique more effective than another? According to the American Psychological Association, three factors work together to produce successful treatment. The first is the use of evidence-based treatment that is deemed appropriate for the client’s particular issues. The second important factor is the clinical expertise of the psychologist or therapist in treating the relevant disorder(s) and how well he or she is trained in the form of therapy. The third factor is the client’s characteristics, values, preferences, and culture and if the client feels comfortable and understood. Many people begin psychotherapy feeling like their problem will never be resolved; however, psychotherapy helps people see that there are steps they can take to make their situation better.

Figure \(\PageIndex{1}\):Therapy comes in many different forms and settings, but one critical factor in its success is the relationship between the therapist and client.

Many studies have explored the effectiveness of psychotherapy. For example, one large-scale study that examined 16 meta-analyses (large-scale summary studies of multiple single study results) of CBT reported that it was equally effective or more effective than other therapies in treating PTSD, generalized anxiety disorder, depression, and social phobia (Butlera, Chapmanb, Formanc, & Becka, 2006). Another study found that CBT was as effective at treating depression (43% success rate) as prescription medication (50% success rate) compared to the placebo rate of 25% (DeRubeis et al., 2005). Another meta-analysis found that psychodynamic therapy was also as effective at treating these types of psychological issues as CBT (Shedler, 2010). However, no studies have consistently found one psychotherapeutic approach more effective than another (Abbass, Kisely, & Kroenke, 2006; Chorpita et al., 2011) across all conditions, nor have they shown any relationship between a client’s treatment outcome and the level of the clinician’s training or experience (Wampold, 2007).

Advocates of this position emphasize a set of common therapeutic factors that produce beneficial outcomes regardless of the model of therapy used. For example, one critical factor that determines the success of treatment is a person’s trusting relationship with the psychologist or therapist (Figure 1). Other key common factors include the following^[1]:

• client factors (making connections with already occurring change patterns in the client’s life, making therapy relevant to the client’s world outside of the therapy session)
• hope and expectancy (enhancing hope and decreasing hopelessness, focusing on realistic interventions, and orienting the client and therapy towards the future)
• novel methods (the therapist provides effective methods that give the client more structure and that offer the client new approaches and new ways to think and behave that address their major concerns)

 

 

Emerging Therapies

Figure \(\PageIndex{2}\): Recent improvements in video chat technology along with the proliferation of mobile devices like smartphones and tablets has made online delivery of therapy more commonplace. [Image: Noba, CC BY 2.0, https://goo.gl/BRvSA7]

With growth in research and technology, psychologists have been able to develop new treatment strategies in recent years. Often, these approaches focus on enhancing existing treatments, such as cognitive-behavioral therapies, through the use of technological advances. For example, internet- and mobile-delivered therapies make psychological treatments more available, through smartphones and online access using specific technologies that encrypt communication and ensure privacy. Clinician-supervised online CBT modules allow patients to access treatment from home on their own schedule—an opportunity particularly important for patients with less geographic or socioeconomic access to traditional treatments. Furthermore, smartphones help extend therapy to patients’ daily lives, allowing for symptom tracking, homework reminders, and more frequent therapist contact (Figure \(\PageIndex{2}\)).

Another benefit of technology is cognitive bias modification. Here, patients are given exercises, often through the use of video games, aimed at changing their problematic thought processes. For example, researchers might use a mobile app to train alcohol abusers to avoid stimuli related to alcohol. One version of this game flashes four pictures on the screen—three alcohol cues (e.g., a can of beer or the front of a bar) and one health-related image (e.g., someone drinking water). The goal is for the patient to tap the healthy picture as fast as he or she can. Games like these aim to target patients’ automatic, subconscious thoughts that may be difficult to direct through conscious effort. That is, by repeatedly tapping the healthy image, the patient learns to “ignore” the alcohol cues, so when those cues are encountered in the environment, they will be less likely to trigger the urge to drink. Approaches like these are promising because of their accessibility; however, they require further research to establish their effectiveness.

Watch It

Review each of the types of psychotherapy you’ve learned about in this module in the following CrashCourse video.

You can view the transcript for “Getting Help – Psychotherapy: Crash Course Psychology #35” here (opens in new window).

Try It

Glossary

cognitive bias modification: the use of apps or video games to help clients work on and achieve therapeutic outcomes using technology

common factors: a common set of factors thought to underlie all forms of psychotherapy and that may be responsible for most of the beneficial outcomes from therapy

Internet and mobile-delivered services: psychotherapy delivered usually in synchronous mode over the phone, tablet, or internet using special technology to ensure privacy and confidentiality

---

1. Duncan, B.L., Miller, S.D. Wampold, B.E. & Hubble, M.A. (Eds). The heart and soul of change (2nd ed). Washington, DC: The American Psychological Association. ↵
2. Burns, D., & 24, D. B. on O. (2020, January 9). The website of David D. Burns, MD: What's the Best School of Psychotherapy?https://feelinggood.com/2017/03/08/4069/. ↵
3. Prochaska, J.O. & Norcross, J.C. (2018). Systems of Psychotherapy: A Transtheoretical Analysis (9th Ed). New York, NY: Oxford University Press. ↵
4. Prochaska, J.O. & Norcross, J.C. (2018). Systems of Psychotherapy: A Transtheoretical Analysis (9th Ed). New York, NY: Oxford University Press. ↵
5. Prochaska, J.O. & Norcross, J.C. (2018). Systems of Psychotherapy: A Transtheoretical Analysis (9th Ed). New York, NY: Oxford University Press, p. 397. ↵
6. Burns, D., & 24, D. B. on O. (2020, January 9). The website of David D. Burns, MD: What's the Best School of Psychotherapy?https://feelinggood.com/2017/03/08/4069/. ↵
7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2860514/ ↵
8. Sammons, M.T. & McGuinness (2015, April). Is a combination of psychotherapy and pharmacotherapy more effective than medication alone for most mental disorders? Do combinations reduce the cost of care? The Tablet. Retrieved from https://www.apadivisions.org/division-55/publications/tablet/2015/04/combininations↵

CC licensed content, Shared previously

• Types of Treatment. Authored by: OpenStax College. Located at: http://cnx.org/contents/Sr8Ev5Og@5.52:N8Hjdi5h@7/Types-of-Treatment. License: CC BY: Attribution. License Terms: Download for free at http://cnx.org/contents/4abf04bf-93a...fd46e68cc@5.48
• Mindfulness, definition of eclectic therapy, and summaries about advantages and disadvantages of treatments from Therapeutic Orientations. Authored by: Hannah Boettcher, Stefan G. Hofmann, and Q. Jade Wu. Provided by: Boston University. Located at: http://nobaproject.com/modules/therapeutic-orientations. Project: The Noba Project. License: CC BY-NC-SA: Attribution-NonCommercial-ShareAlike
• Counseling image. Authored by: Jefferyrauschert. Located at: https://commons.wikimedia.org/wiki/File:Delta_College_Counseling_and_Career_Services.jpg. License: CC BY-SA: Attribution-ShareAlike
• Eclectic psychotherapy. Provided by: Wikipedia. Located at: https://en.Wikipedia.org/wiki/Eclectic_psychotherapy. License: CC BY-SA: Attribution-ShareAlike

All rights reserved content

• Getting Help - Psychotherapy: Crash Course Psychology #35. Authored by: Hank Green. Provided by: CrashCourse. Located at: https://www.youtube.com/watch?v=6nEL44QkL9w&index=35&list=PL8dPuuaLjXtOPRKzVLY0jJY-uHOH9KVU6. License: Other. License Terms: Standard YouTube License