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Dimidjian, S. & Hollon, S. D. (2010). American Psychologist, 65(1). 21-33.

Patients can be harmed by treatment or by the decisions that are made about those treatments. Although dramatic examples of harmful effects of psychotherapy have been reported, the full scope of the problem remains unclear. The field currently lacks consensus about how to detect harm and what to do about it when it occurs. In this article, we define the ways in which treatment (or the inferences about treatment) can do harm and discuss factors that complicate efforts to detect harm. We also recommend methods to detect and understand harm when it occurs, drawing from and modifying many of the same strategies that are used to detect benefit. Specifically, we highlight the value of establishing independent systems for monitoring untoward events in clinical practice, reporting descriptive case studies and qualitative research, and making

use of information from randomized clinical trials, including examining potential active ingredients, mechanisms, moderators, and a broad range of outcomes measured over time. We also highlight the value of promoting discussion in the field about standards for defining and identifying harm.

Clients: The neglected common factor in psychotherapy.

Bohart, A. C., Tallman, K. (2010). In: The heart and soul of change: Delivering what works in therapy (2nd ed.). B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.) Washington, DC, US: American Psychological Association, 83-111.

Professional discourse and practice have long privileged the position and point of view of the therapist. The time has come to spotlight the largest yet most neglected factor in treatment outcome: the client. Although experimental studies of client factors are few and far between and most research favors correlational, qualitative, and retrospective designs, a strong case emerges for the potency of the human client in successful psychotherapy. This chapter begins with a short survey of the potential for self-righting and self-healing. We then consider research regarding the client's role as an active contributor to the therapy process. We review data regarding the factors traditionally thought to account for the effectiveness of psychotherapy and offer an alternative account highlighting the importance of the client. The chapter concludes with the assertion that the client offers the best explanation for the dodo verdict as well as a discussion of the implications of a client-centered paradigm for psychotherapy practice, training, and the broader field of mental health

Outcomes management, reimbursement, and the future of psychotherapy.

Brown, G. S. & Minami, T. (2010). In: The heart and soul of change: Delivering what works in therapy (2nd ed.). B. L. Duncan, S. D. Miller, B. E. Wampold & M. A. Hubble. (Eds.) Washington, DC, US: American Psychological Association, 2010. pp. 267-297.

In this chapter, we present a historical overview of psychotherapy reimbursement, examine the current of the market forces that are eroding the value of psychotherapy services, and argue that outcomes management offers a pathway out of our current predicament. Addressing the serious financial and marketing problems facing future clinical practice, the content of this chapter may feel removed from the warm and fuzzy world of psychotherapy, and perhaps, unlike the rest of the book, even heartless and soulless by conceptualizing psychotherapy as a commodity. To put it bluntly, however, there will be no future if the field fails to face the harsh realities of the business world. The absence of marketing by professional organizations makes naive the assumption that there will be any growth in demand for the services therapists offer (other than keeping up with population growth). Indeed, studies have found psychotherapy utilization rates have remained relatively flat over the years (less than 4%; Weissman et al., 2006). We explore strategies for sustaining psychotherapy as a business under these challenging circumstances in the context of

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