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Tuesday, 4 October 2011

Why Client Choice Determines Psychotherapy Outcomes

Placebos have long been seen as an irritating confounding factor in medical research that needs to be controlled. It's therapeutic sister "Non-specific effects" in the psychotherapy field has also been relegated to a factor to be controlled in recent years. And yet, there is considerable research highlighting the substantial role such factors play over and above specific therapeutic effects. Recent research by Professor Michael Hyland at Plymouth University suggests a mechanism behind non-specific effects which has big practical implications for therapists. Put briefly he has discovered that one of the key mechanisms within placebo is the degree to which the proposed "therapy" is explained or perceived in ways which are consistent with client values and goals. This is independent of whether the client actually believes the "therapy" will work. This has big implications. Firstly it explains the discrepancy that often occurs between RCT therapy results and "on-the-ground" therapeutic effectiveness. Secondly, it suggests that client choice of the therapy they use will have a big impact on outcome. I am much more likely to choose a therapy (as a client) that is presented or perceived as being more consistent with my values. It equally suggests that therapists' statements such as " the client isn't very psychologically minded" or " Mandated clients don't change" or "Clients need to be socialised into the therapeutic model" MAY in fact have a more than a grain of truth in them, even if the phrasing isn't quite right!

1 comment:

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