A TERM PAPER ON PSYCHOTHERAPY

COURSE CODE: NSG 416

COURSE TITLE: MENTAL HEALTH AND PSYCHIATRIC HEALTH

NURSING

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 TABLE OF CONTENT

CONTENT PAGE NUMBER

COVER PAGE 1

TABLE OF CONTENT 2

INTRODUCTION 3-5

APPROCHES TO PSYCHOTHERAPY 5-12

HARMFUL EFFECT OF PSYCHOTHERAPY 12-13

EFFECT OF PSYCHOTHERAPY 13-14

REFRENCES 15

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 CHAPTER ONE

1.0 Introduction

The term psychotherapy is derived from Ancient Greek psyche (meaning "breath; spirit; soul")
and therapeia ("healing; medical treatment"). The Oxford English Dictionary defines it now as
"The treatment of disorders of the mind or personality by psychological methods''. The American
Psychological Association adopted a resolution on the effectiveness of psychotherapy in 2012
based on a definition developed by John C. Norcross: "Psychotherapy is the informed and
intentional application of clinical methods and interpersonal stances derived from established
psychological principles for the purpose of assisting people to modify their behaviors, cognitions,
emotions, and/or other personal characteristics in directions that the participants deem desirable"
(Norcross et al.,2013).

Historically, psychotherapy has sometimes meant "interpretative" (i.e. Freudian) methods,

namely psychoanalysis, in contrast with other methods to treat psychiatric disorders such as
behavior modification.(Eysenk, Hans, 2004). Psychotherapy is often referred to as a "talking
treatment" because it uses talking, rather than medication, particularly for a general audience,
though not all forms of psychotherapy rely on verbal communication.

Psychotherapy is a type of therapy used to treat emotional problems and mental health
conditions. Psychotherapy usually involves talking, but sometimes other methods may be used –
for example, art, music, drama and movement. Psychotherapy can help an individual discuss
feelings they have about themselves and other people, particularly family and those close to them.
In some cases, couples or families are offered joint therapy sessions together.

According to the American Psychological Association (APA), psychotherapy can be defined as

a “collaborative treatment between an individual and a psychologist” where the psychologist uses
“scientifically validated procedures to help people develop healthier, more effective habits“. It
aims to enable patients, or clients, to understand their feelings, and what makes them feel positive,
anxious, or depressed. This can equip them to cope with difficult situations in a more adaptive
way. Psychotherapy can provide help with a range of problems, from depression and low self-
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esteem to addiction and family disputes. Anyone who is feeling overwhelmed by their problems
and unable to cope may be able to benefit from psychotherapy.

Some forms of psychotherapy last only a few sessions, while others are long-term, lasting for
months or years. Sessions are usually for 1 hour, once a week, and they follow a carefully
structured process. Sessions may be one-to-one, in pairs, or in groups. Techniques can include
other forms of communication, such as drama, narrative story, or music.

Psychotherapists are mental health professionals who are trained to listen to a person's
problems to try to find out what's causing them and help them find a solution. As well as listening
and discussing important issues with people, a psychotherapist can suggest strategies for resolving
problems and, if necessary, help them change their attitudes and behavior. Some therapists teach
specific skills to help people tolerate painful emotions, manage relationships more effectively, or
improve behaviour. In group therapy, the members support each other with advice and
encouragement. A therapist will treat sessions as confidential. This means client can trust them
with information that may be personal or embarrassing.

A psychotherapist may be a psychologist, a marriage and family therapist, a licensed clinical

social worker or mental health counselor, a psychiatric nurse practitioner, psychoanalyst, or
psychiatrist.

Psychotherapy can be used to help a range of people. The following feelings are signs that an
individual might benefit from this type of therapy;

Overwhelming feelings of sadness or helplessness.

An inability to cope with everyday problems.

Difficulty concentrating on work or studies most of the time.

Drinking too much, taking drugs, or being aggressive to an extent that is harming themselves or
others.

A sense that problems never improve, despite receiving help from friends and family.

Feeling constantly on edge or worrying unnecessarily.

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 It can also be used to treat a wide range of mental disorders such as;

depression

anxiety disorders

borderline personality disorder (BPD)

obsessive compulsive disorder (OCD)

post-traumatic stress disorder (PTSD)

long-term illnesses

eating disorders, such as anorexia nervosa, bulimia and binge eating

drug misuse

1.1 Approaches to psychotherapy

Psychotherapy can be grouped into three major categories:

Insight-oriented therapy
Task-oriented therapy
Experience-oriented therapy

A. Insight oriented therapy

The subgroups under this category include:

Psychoanalysis
Psychodynamic therapy
Interpersonal therapy

PSYCHOANALYSIS

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This is the oldest and best known of the insight-oriented therapies. It is derived from the Freudian
view of psychosexual development. Psychoanalysis is a form of psychotherapy focusing on the
uncovering of unconscious memories and processes. Psychoanalysis is based on the observation
that individuals are often unaware of many of the factors that determine their emotion and
behavior. These unconscious factors may create unhappiness, sometimes in form of recognizable
symptom and at other times as troubling personality traits, difficulties in work or relationships, or
disturbances in mood and self-esteem.

This approach focuses on changing problematic behaviours, feelings, and thoughts by discovering
their unconscious meanings and motivations. Psychoanalytically oriented therapies are
characterized by a close working partnership between therapist and patient. Patients learn about
themselves by exploring their interactions in the therapeutic relationship. While psychoanalysis is
closely identified with Sigmund Freud. It has been extended and modified since his early
formulations.

The process of psychoanalysis is highly individualized, and its course is dictated both by the
nature of presenting problems and by personalities and background of both the analyst and the
client. For this reason, it is often hard to describe a “typical” psychoanalysis. Most psychoanalysts
believe in the process of “repression” in which painful memories, thoughts and experiences are
actively kept out of conscious awareness. These memories may have highly emotional content; for
example, such memories may involve violence or sexual experiences. However, the analyst’s goal
is to uncover such unconscious experiences and to interpret them to a client who finds them
painful and frightening.

TECHNIQUES OF PSYCHOANALYSIS

TECHNIQUE EXAMPLE

Suggestion: a technique in which the analyst Analyst state, ‘your recurrent dreams about
tentatively interpret the clients thoughts, taking test may be an indication of your worry
actions or dreams about success.’

Catharsis: the experience of release that occurs Clients state ‘I feel relieved. I can now see that
by bringing unconscious thought through
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consciousness in efforts to cure psychological the fearful figure in my dream is my father.’
symptoms

Manipulation: a technique where the analyst Analyst state ‘you just think you can’t
tries actively to influence the client’s feelings remember your dreams. I will bet if you write
about the therapy, with the goal of enhancing them in the morning as soon as you wake up,
the quality of the therapy you’ll be able to remember.’

Confrontation: the analyst directly challenges Analyst state, ‘you have a pattern of dealing
the client’s behavior or thoughts, usually with anger by laughing that is an indirect
intended to provoke a reaction from the clients. means of expressing anger.’
Such reactions are intended to overcome
emotional barriers to change.

Clarification: the analyst describes the client’s Analyst state ‘you are relating to your boss the
behavior, pointing out a pattern that is not same way you relate to your father.’
recognized by the clients.

Interpretation: The analyst brings her Analyst state, ‘you are angry with me because
understanding of a client’s unconscious I’m telling you the same things your mother
processes to explain behavior. told you.’

PSYCHODYNAMIC THERAPY

It is a brief therapy based on psychoanalytic principles and interpretation. Psychodynamic therapy

attempts to replace full psychoanalysis with a process that focuses on selected therapeutic issues
so as to get more rapidly to what the therapist perceives to be the core of the individual’s
psychological distress. The goal of this therapy is improved function rather than complete
personality reconstruction. Psychodynamic therapy may take place over a few months or weeks,
rather than the years occupied by traditional psychoanalysis.

INTERPERSONAL THERAPY

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Although it is an insight-based therapy, it is not derived from psychoanalytic perspective.
Interpersonal therapy is based on the recognition that psychological distress frequently occurs in
conjunction with disturbed human relationships. Interpersonal therapy is based on interpersonal
theories of Sullivan and the related nursing theory of Peplau.

B. Task-oriented therapy

In recent years, the predominance of psychoanalytic methods has been giving way to a newer
approach to mind; cognitive behavioral therapy. Cognitive behavioral therapy is not about gaining
insight into the presumed childhood origin of problems. It is not just about venting feelings or
talking about problems rather it focuses practical results. The main issue is not how an individual
got to be the way he is; it is helping that individual make practical changes.

This approach focuses on learning’s role in developing both normal and abnormal behaviours.
Ivan Pavlov made important contributions to behaviour therapy by discovering classical
conditioning, or associative learning. Pavlov’s famous dogs, for example, began drooling when
they heard their dinner bell, because they associated the sound with food.
Desensitizing is classical conditioning in action: A therapist might help a client with a phobia
through repeated exposure to whatever it is that causes anxiety. Another important thinker was
E.L. Thorndike who discovered operant conditioning. This type of learning relies on rewards and
punishments to shape people’s behaviour. Several variations have developed since behaviour
therapy’s emergence in the 1950s. One variation is cognitive-behavioural therapy, which focuses
on both thoughts and behavior.

COGNITIVE BEHAVIOURAL THERAPY

Psychologist Aaron Beck developed the cognitive therapy concept in the 1960s. The treatment is
based on the principle that maladaptive behavior (ineffective, self-defeating behavior) is triggered
by inappropriate or irrational thinking patterns, called automatic thoughts. Instead of reacting to
the reality of a situation, an individual automatically reacts to his or her own distorted viewpoint
of the situation. Cognitive therapy focuses on changing these thought patterns (also known as
cognitive distortions), by examining the rationality and validity of the assumptions behind them.
This process is termed cognitive restructuring.
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Cognitive behavioral therapy (CBT) is a short-term, goal-oriented psychotherapy treatment that
takes a hands-on, practical approach to problem-solving. Its goal is to change patterns of thinking
or behavior that are behind people’s difficulties, and so change the way they feel. It is used to help
treat a wide range of issues in a person’s life, from sleeping difficulties or relationship problems,
to drug and alcohol abuse or anxiety and depression. CBT works by changing people’s attitudes
and their behavior by focusing on the thoughts, images, beliefs and attitudes that are held (a
person’s cognitive processes) and how these processes relate to the way a person behaves, as a
way of dealing with emotional problems.
An important advantage of cognitive behavioral therapy is that it tends to be short, taking five to
ten months for most emotional problems. Clients attend one session per week, each session lasting
approximately 50 minutes. During this time, the client and therapist are work together to
understand what the problems are and develop new strategies for tackling them. CBT introduces
patients to a set of principles that they can apply whenever they need to, and that’ll last them a
lifetime.
Cognitive behavioral therapy can be thought of as a combination of psychotherapy and behavioral
therapy. Psychotherapy emphasizes the importance of the personal meaning we place on things
and how thinking patterns begin in childhood. Behavioral therapy pays close attention to the
relationship between our problems, our behavior and our thoughts. Most psychotherapists who
practice CBT personalize and customize the therapy to the specific needs and personality of each
patient.
GOALS OF COGNITIVE THERAPY INCLUDE:
the promotion of self-awareness and emotional intelligence by teaching clients to “read” their
emotions and distinguish healthy from unhealthy feelings
helping clients understand how distorted perceptions and thoughts contribute to painful feelings
the rapid reduction of symptoms with an emphasis on examining the client’s current situation and
solving current problems
the development of self-control by teaching clients specific techniques to identify and challenge
distorted thinking
prevention of future episodes of emotional distress and development of personal growth by
helping clients change core beliefs that are often at the heart of their suffering.

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TREATMENT TECHNIQUES
Cognitive therapy is usually administered in an out-patient setting (clinic or doctor's office) by a
therapist trained or certified in cognitive therapy techniques. Therapy may be in either individual
or group sessions, and the course of treatment is short compared to traditional psychotherapy
(often 12 sessions or less). Therapists are psychologists (Ph.D., Psy.D., Ed.D., or M.A. degree),
clinical social workers (M.S.W., D.S.W., or L.S.W. degree), counsellors (M.A. or M.S. degree),
or psychiatrists (M.D. trained in psychiatry).
Therapists use several different techniques in the course of cognitive therapy to help patients
examine thoughts and behaviors. These include:
Validity testing; The therapist asks the patient to defend his or her thoughts and beliefs. If the
patient cannot produce objective evidence supporting his or her assumptions, the invalidity, or
faulty nature, is exposed.
Cognitive rehearsal; The patient is asked to imagine a difficult situation he or she has encountered
in the past, and then works with the therapist to practice how to successfully cope with the
problem. When the patient is confronted with a similar situation again, the rehearsed behavior will
be drawn on to deal with it.
Guided discovery; The therapist asks the patient a series of questions designed to guide the patient
towards the discovery of his or her cognitive distortions.
Journaling; Patients keep a detailed written diary of situations that arise in everyday life, the
thoughts and emotions surrounding them, and the behavior that accompany them. The therapist
and patient then review the journal together to discover maladaptive thought patterns and how
these thoughts impact behavior.
Homework; In order to encourage self-discovery and reinforce insights made in therapy, the
therapist may ask the patient to do homework assignments. These may include note-taking during
the session, journaling (see above), review of an audiotape of the patient session, or reading books
or articles appropriate to the therapy. They may also be more behaviorally focused, applying a
newly learned strategy or coping mechanism to a situation, and then recording the results for the
next therapy session.

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Modelling; Role-playing exercises allow the therapist to act out appropriate reactions to different
situations. The patient can then model this behavior.
COMMON TECHNIQUES USED IN COGNITIVE BEHAVIORAL THERAPY
One of the biggest differences between cognitive behavioral therapy and other common types of
psychotherapy is the structure of the therapeutic session. Cognitive behavioral therapy is highly
structured. A standard session typically follows this protocol:
The client and therapist discuss the specific problems that will be their focus for the week.
The therapist and client begin planning strategies for how to deal with the stated problems.
Together, the client and therapist review the client’s homework from the previous week’s session
and discuss the client’s progress.
Based on the client’s progress and newly determined goals, the therapist assigns new homework
for the following week.
All of this takes place during a standard 50-minute session. Given the time constraint, sessions are
used as a forum for reviewing ideas and checking on progress.
Homework is an essential component to the success of the cognitive behavioral model, and it is up
to the client to complete the homework tasks and keep up with the expectations that are agreed
upon during each counselling session.
CBT homework often includes thought experiments, worksheets, and other behavioral learning
strategies.
COMMON MENTAL HEALTH CONDITIONS ADDRESSED BY COGNITIVE
BEHAVIORAL THERAPY
Cognitive behavioral therapy works best when an individual want to focus on a particular
problem. The therapist and client work together in their sessions to set goals that will lead to
specific outcomes to address the client’s concern. For this reason, cognitive behavioral therapy
may not be ideal for someone who is seeking to address vague or uncertain causes of unhappiness.
For individuals facing specific issues and who have particular outcomes in mind, cognitive
behavioral therapy is often a successful mode of treatment. Some of the major mental health
concerns that CBT can be used to address include:
Anger management
Social anxiety

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Depression
Panic or anxiety attacks
Obsessive-compulsive disorder
Sleep problems
Mood swings
Eating disorders
Drug abuse and alcohol dependency
Relationship and sex issues
This list is not comprehensive; rather, it identifies some of the most common mental health
concerns for which CBT can be successfully employed. The best way to determine if an issue can
be addressed via CBT is for the client and therapist to engage in a consultation regarding the
issues at hand and to discuss the potential benefits and outcomes of utilizing the cognitive
behavioral therapeutic model for treatment.

AUTOMATIC THOUGHTS
Automatic thoughts, a concept in cognitive behavioral therapy, are images or mental activity that
occur as a response to a trigger (like an action or event). They are automatic and 'pop up' or 'flash'
in your mind without conscious thought. Automatic thoughts can be beneficial. For example, you
are driving and it starts raining very heavily. Automatically you think 'I need to be careful!' which
leads to feelings of anxiety that cause you to drive more cautiously. Automatic thoughts can also
have negative effects for people who have trouble with depression or anxiety.
For example, a person with anxiety sees an acquaintance frowning in their direction. They
immediately think 'That person hates me!' which leads to feelings of anxiety, worry, and sadness.
Thoughts like this can be damaging and unnecessary- the person who was frowning just had a
pain in their leg! Cognitive behavioral therapy focuses on negative thought patterns and automatic
thoughts that make people depressed or anxious. By changing these patterns and discerning how
they occur can help treat emotional problems.
What are the advantages of using CBT?
Long-term outcome

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CBT has been shown to have an enduring positive effect for patients. In a randomised
trial, Dobson et al. (2008) found that depressed patients who had previously been treated with
anti-depressant medication (ADM) had a greater chance of relapse through 1-year follow-up than
patients who had previously received CBT. In fact, prior CBT had an enduring effect (in terms of
prevention of relapse and recurrence during the follow-up period) that was at least as strong as
continuing patients on ADM.
Cost-effectiveness
In a randomised trial of CBT and ADM, Dobson et al. (2008) found that, although CBT was more
expensive to provide initially, the cumulative cost of continued medications proved to be more
expensive by the end of the first year of follow-up. Furthermore, mindfulness-based CBT is a
particularly cost-effective approach, because it is delivered in a group format.

Experienced-oriented therapy

This therapy focuses on clients experience as an agent for producing change. The client’s
experience is facilitated by a therapist who has assessed the clients and who directs experiences to
produce a calculated change in behavior and feeling. Experience-oriented therapy engages the
clients in new interactions and the new ways-of-being within the therapy session.

CLIENT-CENTERED THERAPY (FOUNDED BY CARL ROGERS)

It is an example of experience-oriented therapy. It is based on the idea that every individual has a
store of internal resources and self-understanding and that this inner resources can be brought out
when the therapist is open non-judgmental and empathic. The therapist seeks to be uniformly
supportive and kind. The therapist attempts to understand client’s inner feelings.

Integrative or holistic therapy: Many therapists don’t tie themselves to any one approach. Instead,
they blend elements from different approaches and tailor their treatment according to each client’s
needs.

1.3 Benefits of psychotherapy

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With an effective therapist, science shows that psychotherapy even works better in the long-term
and is more enduring than medication. In fact, not only is it more cost-effective, but leads to fewer
relapses of anxiety and mild to moderate depression than medication use alone. A major
advantage over treatment with medication is that psychotherapy has few physiological side effects
—an especially important consideration for older adults who are often taking more than one type
of medication. In addition, it offers the possibility of effective treatment for those who have not
responded to medications. The best research evidence conclusively shows that individual, group
and couple/family psychotherapy are effective for a broad range of disorders, symptoms and
problems with children, adolescents, adults, and older adults (American Group Psychotherapy
Association, 2007).Whereas, the development and/or adaptation of evidence-based psychotherapy
practices for each age group have further demonstrated effectiveness in reducing symptoms and
improving functioning across the lifespan Other benefits include;

IT GIVES CLIENT SOMEONE TO TALK TO; The health professional provides the client a
channel to unburden their worries and thoughts, having someone to talk to is the central theme of
this form of treatment, by talking to another person it gives the client an opportunity to explore,
critically explore and look back at their actions, this allows the client and the health professional
look at the situation from another angle. Expressing thoughts with a professional non-judgmental
person can make someone feel less alone and be able to sort out thoughts in a productive way.

ALLOWS CLIENT GAIN A DEEPER UNDERSTANDING OF THEMSELVES; During

psychotherapy, clients are made to confront emotions such as fear, grief, regret and wants that
they otherwise ignore, by doing this the client is able to reflect all facet of their lives, relationship
with others, work and career, spirituality etc. the client is able to have a holistic view in defining
who they are. They are made to acknowledge their own goals, values, strengths and limitations,
furthermore, psychotherapy improves self –awareness.

OVERCOMING SPECIFIC PROBLEMS; Over the course of life, individuals are presented with
different challenges from which problems arise at some point, sometimes this problem become
insurmountable and the person might need help overcoming such problem.

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During psychotherapy , problems are identified by both the client and the practitioner and the
sessions provides an avenue in tackling these problems, such problems might not be identified by
the client but, however, it impedes the growth and happiness of the client, example include
phobia, anger, frustration etc.

DEVELOPING EFFECTIVE COPING MECHANISM; In mental health and psychology,

adaptation refers mechanisms used to manage environmental stress that is based on conscious or
unconscious choice and enhances control over behaviour or gives psychological comfort. This
coping mechanism although alleviates the stress for the client, may sometimes be detrimental or
counterproductive to the client, for example avoiding relationships to deal with fear of betrayal or
losing someone. Psychotherapy helps the client develop an effective and efficient mechanisms in
managing relationships, painful conflicts, memories and other aspects of their life.

TREATMENT OF DEPRESSION; Depression is a state of low mood and aversion to activity that
can affect a person's thoughts, behaviour, tendencies, feelings, and sense of well-being
(Wikipedia) affecting 1 in 15 adults every year (APA) .Psychotherapy, is sometimes used alone
for treatment of mild depression; for moderate to severe depression, psychotherapy is often used
in along with antidepressant medications. Cognitive behavioural therapy (CBT) has been found to
be effective in treating depression (APA).

IMPROVED JUDGEMENT AND FOCUS; Decision making is improved when there is clarity of
thoughts and emotions are properly managed. By sorting through thoughts and emotions, client
are able to prioritize events and people in their life and come in terms with what is important.

1.4 Despite these benefits, psychotherapy can also be harmful;

David Barlow (2010) a well-respected psychologist and researcher considered the negative side
effects of psychotherapy and he said we can no longer make the claim that psychotherapy can
have no negative side effects, even when wielded by an ethical and experienced therapist.

One of the best examples of this that Barlow noted is the research into something called
“critical incident stress debriefing” (CISD). This is a therapeutic technique meant to help people
immediately after experiencing a trauma in their lives (such as a natural disaster or car accident).
The common wisdom is that counselling immediately after a trauma is likely to be beneficial to
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the victims. But what the research has found is that in groups of people who have been treated
with CISD actually experience greater and more severe symptoms when later measured. This
made little sense to researchers — how could people who’ve actually been given a psychological
intervention then later go on to experience even worse symptoms.

A more refined analysis found that it was actually only people who had high scores on a
measure of the impact of the traumatic event who fared much worse later on after the
psychological intervention. People with low scores on the same measure did just fine with the
intervention. Barlow’s point is that we often can’t see the important variables that could have a
negative impact in treatment until we take apart the data and examine it more closely.

Another example Barlow noted of negative side effects for a therapeutic technique is the use of
breathing retraining and relaxation procedures during exposure-based procedures for individuals
with panic disorder with agoraphobia. People who were taught these techniques actually fared
worse off in coping with their panic than those who were not taught to use them. In other words,
just because a therapeutic technique is useful in one situation outside of exposure procedures, for
instance, to help reduce anxiety or tension doesn’t mean it might not be harmful in other
situations.

These are often difficult cases to find, because just like psychiatric medications’ side effects,
not everyone will experience them in every setting. There are specific traits or symptoms that may
preclude the use of specific therapeutic techniques. To say nothing of normally-beneficial
therapeutic techniques used inappropriately by inexperienced or poorly trained therapists.

Psychotherapy is a powerful treatment for mental health concerns. It’s time that more focus be
given not only to its beneficial effects, but also to better understand when certain techniques are
best not used and could, in fact, be harmful.

1.5 Effects of psychotherapy

Discussion about side effects, risks and benefits are an important part of psychotropic
medication, the same cannot be said for psychological treatments. All pharmacological
medications come with relevant or absolute contraindications, and yet the common assumption is
that talking therapies are risk-free or come with little risk at all. It is important to recognize that
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psychotherapy is not free from side effects with a range of potentially negative patient outcomes
in the context of treatment. These negative effects of psychotherapy occur when treatment
exacerbates existing problems are leads to the occurrence of new symptoms or problems which
are not themselves resolved in the course of psychotherapy. The new symptoms, which include
the development of interpersonal difficulties or issues within the family or at work, are possible
signs of a negative impact of psychotherapy. Furthermore, the negative impact of psychotherapy
may cause a significant decline or deterioration in existing symptoms. It is, therefore, reasonable
that assessment of negative changes should be implemented as routine assessment even when
providing evidence-based care

Ways to Improve Psychotherapy Outcome

Monitor Outcomes

Routine monitoring of outcomes and providing therapists with feedback on their client’s
progress improves care.

2. Provide a Theoretically Explicit Rationale for Change

People want an explanation for their distress. One common factor in any effective
psychotherapy is that therapists provide to patients an explicit rationale for change that is
embedded in a psychological theory. In other words, it is imperative that therapists clearly
describe to clients why they are distressed and how therapy will help them change. When
therapists provide a clear theory derived rationale, they express credibility and confidence in the
treatment they are going to provide and create positive expectations for change, thereby raising
the likelihood that patients will participate in the treatment, factors which are associated with
outcome.
3. Highlight Role Induction into the Therapy Process
Clients should understand their role in the change process and what actions they are
responsible. Role induction is a critical part of any effective therapy and an aspect of care that is
often neglected.
4. Be Flexible in Treatment Planning

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 Strict adherence to a theoretical model results in poor outcomes, whereas adherence flexibility
is associated with positive outcomes.
5. Address Difficult Emotional Material
Therapists who are engaging, confident, active, and persuasive have better psychotherapy
outcomes. Part of this entails persuading and engaging the client in order to discuss challenging
emotional material. That is to help the client process emotions they likely wish to avoid.
7. Limit Self-Disclosure That Is Non-Therapeutic
Too much self-disclosure that is off topic, countertransference related, or involves the overuse
of interpretation in session can have deleterious effects on psychotherapy outcome. Therapists
would do well to ask themselves one simple question: “Am I talking too much?” and “Is the talk
directed toward helping the patient?".

References;
Elliott, R., Bohart, A., Watson, J., & Greenberg, L. (2011). Psychotherapy,
48(1), 43-49.

Barlow, D.H. (2010). Negative effects from psychological treatments. American Psychologist,

65, 13-19.
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Wikipedia

American psychological association

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