Methodology of Inquiring “Therapy Failure” in Psychotherapy Research: Practical Guide for Clinical Practitioners and Researchers

Document Type : Original Article

Authors

1 Department of Psychology, Faculty of Humanities, Tarbiat Modares University, Tehran, iran

2 Department of Psychology, Faculty of humanities, Tarbiat Modares University, Tehran, Iran

3 Department of Psychology, Faculty of Humanities, Shahed University, Tehran, Iran

4 Department of Psychology and Exceptional Children Education, Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran

5 Department of Psychology, Tarbiat Modares University,Iran

6 Department of Clinical psychology, School of Behavioral Sciences & Mental Health, Iran University of Medical Sciences, Tehran, Iran

7 PhD in Psychology, Department of Psychology, Tehran, Iran

Abstract

Psychotherapy is one of the most important and attractive directions in psychology. Most of the researches are concentrating on the statistical and clinical significance of psychological treatment in comparing a given treatment group with the other groups or placebo ones. It is worth noting that therapy leads always to no positive outcome. Sometimes it makes some clients worse and some of them remain without any change (no change). The therapy failure has been ignored. The focus on statistical and clinical significance which is predominantly evaluated using quantitative pre-post outcome questionnaires remains unclear what this means for clients in their real situations. To do this, it is needed to combine treatment evaluation with quantitative and qualitative outcome measures. This paper aimed to provide a theoretical view and practical steps for inquiring therapy failure: “no changing” and “deteriorating” after receiving therapy. Finding the roots of this failure improvement the theoretical basis in explanation of a psychological disorder and the related psychotherapeutic package. This paper stayed away from theoretical and practical ignorance

Keywords


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    1. Kühberger, A., Fritz, A., & Scherndl, T. "Publication Bias in Psychology: A Diagnosis Based on the Correlation between Effect Size and Sample Size." PloS One, 2014; 9(9), e105825.
    2. Lambert, M. J. "Presidential address: what we have learned from a decade of research aimed at improving psychotherapy outcome in routine care".Psychother. Res, 2007; 17, 1–14.
    3. Lampropoulos, G. K.Failure in psychotherapy: an introduction. J. Clin.Psychol, 2011; 67, 1093–1095.
    4. Mays, D. T., and Franks, C. M. Negative Outcome in Psychotherapy and What to do about it. New York, NY: Springer. 1985.
    5. Mehler, D. M. A., Edelsbrunner, P. A., & Matić, K. Appreciating the Significance of Non-significant Findings in Psychology. Journal of European Psychology Students, 2019; 10(4), 1–7.
    6. Bohart, C. A., and Wade, A. M. The client in psychotherapy in Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, 6th 2013.
    7. Barlow, D. H. Negative effects frompsychological treatments: a perspective. Am. Psychol. 65, 13–20. Doi: 10.1037/ a0015643, 2010.
    8. Blanton, H., and Jaccard, JArbitrary metrics in psychology. Am. Psychol, 2006; 61, 27–41
    9. Algermissen, J., & Mehler, D. M. A. May the power be with you: are there highly powered studies in neuroscience, and how can we get more of them? Journal of Neurophysiology, 2017; 119(6), 2114–2117.
    10. Fidler, F., Singleton Thorn, F., Barnett, A., Kambouris, S., &Kruger, AThe Epistemic Importance of Establishing theAbsence of an Effect. Advances in Methods and Practices in Psychological Science, 1(2), 237–244. 2018.
    11. Hoekstra, R., Finch, S., Kiers, H. A., & Johnson, A. Probability as certainty: Dichotomous Thinking and the Misuse of p-values. Psychonomic Bulletin & Review, 2006; 13(6), 1033–1037.
    12. Jacobson, N. S., Roberts, L. J., Berns, S. B., and McGlinchey, J. B. Methods for defining and determining the clinical significance of treatment effects: description, application, and alternatives. J. Consult. Clin. Psychol.1999; 67, 300–307
    13. Kazdin, A. E. Almost clinically significant (p<.10): current measures may only approach clinical significance. Clin. Psychol, 2001; 8, 455–462.
    14. Kazdin, A. E. Arbitrary metrics: implications for identifying evidence-based treatments. Am. Psychol. 2006; 61, 42–71.
    15. Hill, C. E., Chui, H., and Baumann, E. Revisiting and envisioning the outcome problem in psychotherapy: an argument to include individualized and qualitative measurement. Psychotherapy, 2003; 50, 68–76
    16. Braakmann, D. Historical paths in psychotherapy research in Psychotherapy Research: Foundations, Process and Outcome, edsO. C. G. Gelo, A. Pritz, and B. Rieken (Vienna: Springer), 2015; 39–66.
    17. McElvaney, J., and Timulak, L. Clients’ experience of therapy and its outcomes in ‘good’ and ‘poor’ outcome psychological therapy in a primary care setting: an exploratory study. Counseling and Psychotherapy. Research, 2003; 13, 246–253.
    18. McLeod, J. Qualitative research. Methods and contributions in Bergin and Garfield’s Handbook of Psychotherapy and Behavior Change, 6th Edn. M. J.Lambert (New York, NY: JohnWiley and Sons), 49–84.2013.
    19. Paulson, B. L., Everall, R. D., and Stuart, J. Client perceptions of hindering experiences in counselling. Couns. Psychother. Res., 2001;1, 53–61.
    20. Lambert, M. J., and Ogles, B. M. Using clinical significance in psychotherapy outcome research: the need for a common procedure and validity data. Psychother. Res.2009; 19, 493–501.
    21. Lambert, M. J., Hansen, N. B., and Bauer, S. “Assessing the clinical significance of outcome results,” in Evidence-Based Outcome Research. A Practical Guide to Conducting Randomized Controlled Trials for Psychosocial Interventions, eds A. M. Nezu and C. M. Nezu (New York, NY: OxfordUniversity Press, Inc.), 359–378.2008.
    22. Lambert,M. J. What have we learned about treatment failure in empirically supported treatments? Some suggestions for practice. Cogn. Behav. Pract, 2011; 18,413–420
    23. Werbart, A., von Below, C., Brun, J., and Gunnarsdottir, H. Spinning one’s Wheels: non-improved patients view their psychotherapy. Psychotherapy. Research, 25.2015.
    24. Cohen, J. The world is round (p < .05). American Psychologist, 1994; 49, 997–1003
    25. Cohen, J. Things I have learned (so far). American Psychologist, 1990; 45, 1304–1312.
    26. Wilkinson, L. The Task Force on Statistical Inference .Statistical methods in psychology: guidelines and explanations. American Psychologist, 1999; 54, 594 – 604.
    27. Nezu, A., M., Nezu, C., M. Evidence-Based Outcome Research: A practical guide to conducting randomized controlled trials for psychosocial interventions.UK: Oxford.2007.
    28. Strauss, A., and Corbin, J. Basics of Qualitative Research Techniques and Procedures for Developing Grounded Theory. London:Sage Publications.1990
    29. Charmaz, K. Constructing Grounded Theory, 2nd Edn. Thousand Oaks.2014.
    30. Fassinger, R. E. Paradigms, praxis, problems, and promise: grounded theory in gounseling psychology research. J. Couns. Psychol, 2005; 52, 156–166.