Handbook of Effective Psychotherapy

509 Pages·1993·21.809 MB·English

by  H. J. Eysenck (auth.), Thomas R. Giles (eds.)

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Handbook of
Effective Psychotherapy
Edited by
Thomas R. Giles
Associate.s in Managed Care
Denver, Colorado
SPRINGER SCIENCE+BUSINESS MEDIA, LLC
L.!br.ary of Congress Cataloglng-ln-Publlcatlon Data
Handbook of effectlve psychotherapy I edlted by Thomas R. Gl1es.
p. cm. -- (The Plenum behavlor therapy serles)
Includes blbl10graphlcal references and Index.
ISBN 978-1-4613-6264-7 ISBN 978-1-4615-2914-9 (eBook)
DOI 10.1007/978-1-4615-2914-9
1. Psychotherapy--Handbooks. manuals. etc. 1. Gl1as. Thomas R.
II. Serles: Plenum behavlor therapy serles.
[DNLM: 1. Psychotherapy--handbooks. HM 34 H2355 19931
RC458.H35 1993
816.89· 14--dc20
DNLM/DLC
for Llbrary of Congress 93-23998
CIP
ISBN 978-1-4613-6264-7
© 1993 Springer Sdence+Business Media New York
Originally published byPlenum Press in 1993
Softcover reprint of the hardcover lst edition 1993
AlI rights reserved
No part of this book may be reproduced, stored in a retrieval. system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, microfilming, recording, or otheIWise, without written permission from the
Publisher
To my parents
JACK AND MARIAN GILES
and to my mentors
FREDERICK]' TODD, Ph.D., and JOSEPH WOLPE, M.D.
Contributors
Francis R. Abueg • Behavioral Science Division, National Center to PTSD, Palo
Alto VAMC, Palo Alto, California 94304.
John P. Allen • National Institute on Alcohol Abuse and Alcoholism, Rockville,
Maryland 20857.
David H. Barlow. Center for Stress and Anxiety Disorders, State University of
New York-Albany, Albany, New York 12203.
Dudley David Blake. Clinical Laboratory and Education Division, National
Center for PTSD, Palo Alto, California 94304.
Joan Busner • Rockland Children's Psychiatric Center, Orangeburg, New York
and College of Physicians and Surgeons of Columbia University, New York, New
York 10027.
Cheryl Carmin • St. Louis University Medical Center, Division of Behavioral
Medicine, St. Louis, Missouri 63104.
Patricia Chamberlin. Oregon Social Learning Center, Eugene, Oregon 97401.
Guylaine Cote. Center for Stress and Anxiety Disorders, State University of
New York-Albany, Albany, New York 12203.
T. J. Dishion • Oregon Social Learning Center, Eugene, Oregon 97401.
Robert Elliott • Department of Psychology, University of Toledo, Toledo, Ohio,
43606.
H. J. Eysenck • Institute of Psychiatry, University of London, London, England.
Thomas R. Giles • Associates in Managed Care, 10200 East Girard Avenue, Suite
C-356, Denver, Colorado 80231.
Shirley M. Glynn • West Los Angeles VA Medical Center (Brentwood Division)
and University of California, Los Angeles, Los Angeles, California 90073. vii
viii Richard G. Heimberg • Center for Stress and Anxiety Disorders, State Univer
sity of New York-Albany, Albany, New York 12205.
Contributors
Craig S. Holt. Iowa City VA Medical Center, Iowa City, Iowa 52246.
Debra A. Hope. Department of Psychology, University of Nebraska-Lincoln,
Lincoln, Nebraska 68588-0308.
Stuart L. Kaplan • Rockland Children's Psychiatric Center, Orangeburg, New
York and College of Physicians and Surgeons of Columbia University, New York,
New York 10027.
Terrence M. Keane • Behavioral Science Division, National Center for PTSD,
Boston VAMC, Boston, Massachusetts 02130.
Judy Lam. School of Social Work, Boston University, Boston, Massachusetts
02215.
Harold Leitenberg • Department of Psychology, Unviversity of Vermont, Bur
lington, Vermont 05405.
Marsha M. Linehan • Department of Psychology, University of Washington,
Seattle, Washington 98195.
John R. Lutzker • Department of Psychology, Lee College of Judaism, Los
Angeles, California 90077.
Margaret E. Mattson • National Institute on Alcohol Abuse and Alcoholism,
Rockville, Maryland 20857.
Kim Meuser • Department of Psychiatry, Medical College of Pennsylvania at
Eastern Pennsylvanis Psychiatric Institute, Philadelphia, Pennsylvania 19129.
Dan M. Neims • University of Denver, Denver, Colorado 80222.
G. R. Patterson. Oregon Social Learning Center, Eugene, Oregon 97401.
Jacqueline B. Persons • Department of Psychiatry, University of California, San
Francisco, California 94143.
Gene Pekarik • Department of Psychology, Washburn University, Topeka, Kan
sas 66621.
c. Alec Pollard. St. Louis University Medical Center, Division of Behavioral
Medicine, St. Louis, Missouri 63104.
Elizabeth M. Prial • University of Denver, Denver, Colorado 80222.
David A. Shapiro • 17 Churchill Avenue, North York, Ontario M2N 122, Canada.
Laurence Shapiro • St. Louis University Medical Center, Division of Behavioral ix
Medicine, St. Louis, Missouri 63104.
Contributors
Tristram Smith. Department of Psychology, University of California, Los An
geles, Los Angeles, California 90024-1563.
Gail Steketee. School of Social Work, Boston University, Boston, Massachusetts
02215.
William B. Stiles. Department of Psychology, Miami Univesity, Oxford, Ohio
45056.
Ralph M. Turner • Center for Research on Adolescents and Families, Temple
University, and Department of Psychiatry, Temple University School of Medicine,
Philadelphia, Pennsylvania 19140.
Darren A. Tutek • Department of Psychology, University of Washington, Seattle,
Washington 98195.
Steven H. Woodward • Clinical Laboratory and Education Division, National
Center for PTSD, Palo Alto, California 94304.
Preface
Handbook ofE ffective Psydwtherapy is the culmination of 15 years of personal interest
in the area of psychotherapy outcome research. In my view, this is one of the most
interesting and crucial areas in the field: it has relevance across disparate clinical
disciplines and orientations; it provides a measure of how far the field has
progressed in its efforts to improve the effectiveness of psychotherapeutic inter
vention; and it provides an ongoing measure of how readily clinicians adapt to
scientific indications in state-of-the-art care.
Regrettably, as several of the chapters in this volume indicate, there is a vast
chasm between what is known about the best available treatments and what is
applied as the usual standard of care. On the most basic level there appears to be a
significant number of clinicians who remain reluctant to acknowledge that scien
tific study can add to their ability to aid the emotionally distressed. I hope that this
handbook, with its many delineations of empirically supported treatments, will do
something to remedy this state of affairs.
There is, of course, another subgroup of clinicians who values the results of
research but believes that all therapies, because of "unspecified" mechanisms, yield
roughly equivalent results. Despite more than a decade of experience with this
reaction, I remain surprised that others still hold to this position given the
published research findings of the last 30 years. I hope that some members of this
subgroup will be sufficiently persuaded by the chapters in this handbook to
experiment with the procedures identified herein to be the most effective. When
ever I read yet another article assuming the equivalence argument, however (and
these are still being published by the score), I realize that this issue is so emotionally
charged that no amount of research will be persuasive to all.
There is yet another subgroup that is receptive to what has been demonstrated
by empirical study but that is unsure of the findings presented in the literature or
where to go to obtain them. This subgroup, which, along with clinicians and
academicians includes managed mental health care companies, administrators,
chief executive officers, human services directors, and other policymakers should
find this handbook of use. The chapters on specific disorders, while cautious as to
the methodological limits of the findings and studies reviewed, provide a direction
for disorder-driven care that stands to improve upon the outcomes usually ob
served.
xi
xii The handbook is organized into three sections. The first part includes two
general reviews. Eysenck first reviews the demonstrated efficacy of the traditional
Preface
psychotherapies. The second review, written by my co-authors and me, provides an
appendix of more than 100 studies indicating that certain types of directive
treatment interventions result in outcomes superior to those observed with more
traditional forms of care.
The next section is a compilation of reviews indicating which treatments
appear to get the best outcomes, organized by disorder. These chapters provide the
essence of the handbook.
The final section represents an attempt to acknowledge that the advances in
research cited in Parts I and II have been accompanied by controversy and by the
discovery of numerous areas in which the field can still improve. Pekarik's chapter,
for example, while acknowledging the superior efficacy of cognitive and behavioral
interventions, points out that these therapies have consistently overlooked various
phenomena from the consumer preference literature. These oversights have ad
versely affected the outcomes of these varieties of care. At my request, Elliott,
Stiles, and Shapiro provide a counterpoint to the thesis of my own chapters and to
that of a number of the disorder-specific chapters. Among other things, this
counterargument points to methodological weaknesses in the research, Rosenthal
effects, and other possible research biases. As an additional attempt to provide a
forum for the expression of countervailing points of view, a chapter on the merits
of integrationism was invited. In this chapter, while also acknowledging the proven
efficacy of cognitive and behavioral techniques, Turner argues that the contribu
tions from other theorists may still lend substantial value and additional effective
ness to what are currently recognized as the most effective forms of care.
As this handbook will make clear, it is very difficult to take a stand on the
comparative effectiveness of virtually any technique, orientation, or procedure
without exciting adverse passions and charges of bias. Ironically, my experience as
editor indicated that, if anything, the authors of the disorder-specific chapters
took great pains to avoid anything but a conservative and cautious approach. I was
interested to observe that, in more than half of the chapters, the authors did not at
first specifically identify a treatment of choice despite their having presented
research findings that justified a preference. I became so intrigued with this
phenomenon that I began an informal survey of the authors' reticence. Their
stated reasons included a fear of "retaliation" or criticism, as has been observed
frequently, from traditionally oriented colleagues; the conservative influence of
scientific training and philosophy of science; and a general distaste for anything
that could be construed as an unreasoned championship of a "cause," regardless of
the degree to which the authors believed their arguments were indeed correct.
Perhaps John Allen, the first author of the chapter on the treatment of alcoholism,
spoke best for the authors with his reply: "We do not wish to condemn the field of
practice, much as it concerns us."
Since completing this handbook, I have left the directorship of a managed
care company in order to start my own consulting firm. As such, I am most