Why do Clinical Psychologists do research?
What should be measured when assessing psychotherapy
Psychological Disorders outcome?
- there is no doctoral degree in psychology in “abnormal Researchers who conduct empirical inquiries about
psychology” or “psychopathology” per se, so psychologists therapy outcome must consider which outcome is most
who choose to conduct basic research on psychological important for the purpose of their particular study and
disorders are typically clinical psychologists. design their outcome measure accordingly.
Is social anxiety disorder experienced differently by men When should psychotherapy outcome be measured?
and women?
The timing of therapy measurements depends on the goal.
- Women are more likely to have the disorder and typically If the focus is evaluative (assessing therapy effectiveness
have more severe symptoms and a higher level of distress after it ends), measurements can be taken immediately
related to it. They are more likely to have comorbid phobias, after therapy or during follow-up periods, such as weeks or
generalized anxiety disorder, and PTSD, whereas men are months later. If the focus is formative (assessing therapy
more likely to have comorbid substance abuse disorder and while it's ongoing to make adjustments), measurements
conduct disorder. can occur at each session or at intervals during therapy.
Researchers may also combine both approaches.
Do specific symptoms of PTSD predict suicidal behavior in
military personnel more than others? Who should rate psychotherapy outcome?
- A study found that hyperarousal symptoms (e.g., agitation) The assessment of psychotherapy outcomes involves
do predict suicidal behavior to a significantly greater extent various parties, each with different perspectives and
than other symptoms of the disorder. biases. Clients are key sources of information but may offer
unreliable views due to personal biases, expectations, or
People with borderline personality disorder often overreact
their psychological issues (e.g., a depressed person
to the possibility of interpersonal rejection, but is it possible
focusing only on negatives). In group therapies, like couples
that they also experience poor connectedness with others
or family therapy, differing opinions among participants
when they are being accepted and included?
may arise. Psychotherapists, though knowledgeable, can
- One study found that people with the disorder (compared also be biased. Additionally, external parties like family
to people without it) did in fact respond more negatively to members, employers, law enforcement, insurance
positive social feedback, for example, they were less companies, and society at large may have a stake in the
cooperative. therapy's results, adding complexity to evaluating its
success.
Treatment Outcome
- Research on this has a rather extensive history, with Hans
Eysenck’s unfavorable review of psychotherapy outcome Efficacy Versus Effectiveness
serving as a landmark study and a catalyst for additional
Efficacy
investigations on the subject.
- refers to the success of a particular therapy in a controlled
study conducted with clients who were chosen according
Measuring Therapy Outcome: Essential Questions to particular study criteria.
How should psychotherapy outcome be measured? - how well it works “in the lab,” where it is practiced
according to manualized methods and where outcome for
Questionnaires are an efficient and convenient method for treated individuals is compared via clinical trial with
evaluating therapy outcomes, and many commonly used outcome for individuals who receive alternate or no
measures are written surveys. However, other methods like treatment.
interviews and direct observation of clients can also be
effective. If questionnaires are the chosen method, more - Participants are often selected on the basis of meeting
specific “how” questions arise, such as the length and strict (e.g., diagnostic) criteria and are randomly assigned
format of the questionnaire. to either a treatment group or a control group.
, - In many cases, more than half of those interested in being Considering Culture
participants are excluded. Those who are included are
Treatments That Work, but for Whom?
typically less severe, more likely to have comorbid
diagnoses, and less likely to be from minority populations ❖ Muñoz and Mendelson (2005) stated, “Clinical
than are comparable clients in actual clinical settings trials have seldom included adequate samples of
people of color. Indeed, most empirically
Effectiveness
supported therapies were evaluated with samples
- refers to the success of a therapy in actual clinical settings drawn primarily from a White, middle class,
in which client problems span a wider range, and clients are English-speaking, female population”
not chosen as a result of meeting certain diagnostic criteria.
❖ Ethnic minorities simply receive less
- how well it works “in the real world,” or how well it
psychotherapy than those in the majority
translates from the lab to the clinics, agencies, hospitals,
private practices, and other settings where clinical
psychologists conduct therapy
Assessment Methods
statistical significance
Clinical psychologists conduct research to evaluate and
- is assessed quantitatively improve the assessment methods they use with clients.
Such studies may involve the development, validation, or
clinical (or real-world) significance
expanded use of new instruments; the establishment of
- is measured more qualitatively normative data for specific populations on an assessment
tool; a comparison of multiple assessment tools to one
another; or other research questions
Internal Versus External Validity Here are a few examples from the spectrum of research
being conducted in this area:
Internal validity
1. A study by Steenhuis et al. (2009) examined the
- refers to the extent to which the change in the dependent
Diagnostic Interview Schedule for Children—Version 4
variable is due solely to the change in the independent
(DISC-IV), comparing an Internet-based, self-administered
variable.
interview with a live clinician's in-person interview for
External validity diagnosing ADHD in children. The results showed a high
correspondence between both methods.
- refers to the generalizability of the result—to what extent
is the same finding valid for different settings and 2. Research by Anastopoulos et al. (2018) explored how
populations. male and female teachers and parents rate boys’ ADHD
symptoms. Female respondents provided consistently
❖ The more “controlled” and internally valid an higher ratings than males, potentially affecting diagnoses.
efficacy study is, the more dissimilar it can become
from therapy in the “real world,” thus undermining 3. Levin-Aspenson & Watson (2018) found that young,
external validity. educated adults reported fewer depressive symptoms in
❖ Efficacy studies are often respected for their interviews than on self-report questionnaires.
internal validity but discounted for their external
4. Wiebe & Penley (2005) compared English and Spanish
validity, whereas the opposite is often true for
versions of the Beck Depression Inventory-II and concluded
effectiveness studies
that the Spanish version was as reliable and valid as the
dissemination strategies English version.
- efforts to promote therapies that have demonstrated 5. Hahn (2005) tested the effectiveness of the Minnesota
effectiveness in treatment studies to large numbers of Multiphasic Personality Inventory-2 (MMPI-2) in detecting
therapists. "faking" in both North American and Korean clients. Results
indicated that the test's scales were effective in both
- Results show that therapists in clinical (as opposed to translations.
research) settings are often less than eager to accept and
use evidence-based therapies and, in some cases, are
quite resistant
What should be measured when assessing psychotherapy
Psychological Disorders outcome?
- there is no doctoral degree in psychology in “abnormal Researchers who conduct empirical inquiries about
psychology” or “psychopathology” per se, so psychologists therapy outcome must consider which outcome is most
who choose to conduct basic research on psychological important for the purpose of their particular study and
disorders are typically clinical psychologists. design their outcome measure accordingly.
Is social anxiety disorder experienced differently by men When should psychotherapy outcome be measured?
and women?
The timing of therapy measurements depends on the goal.
- Women are more likely to have the disorder and typically If the focus is evaluative (assessing therapy effectiveness
have more severe symptoms and a higher level of distress after it ends), measurements can be taken immediately
related to it. They are more likely to have comorbid phobias, after therapy or during follow-up periods, such as weeks or
generalized anxiety disorder, and PTSD, whereas men are months later. If the focus is formative (assessing therapy
more likely to have comorbid substance abuse disorder and while it's ongoing to make adjustments), measurements
conduct disorder. can occur at each session or at intervals during therapy.
Researchers may also combine both approaches.
Do specific symptoms of PTSD predict suicidal behavior in
military personnel more than others? Who should rate psychotherapy outcome?
- A study found that hyperarousal symptoms (e.g., agitation) The assessment of psychotherapy outcomes involves
do predict suicidal behavior to a significantly greater extent various parties, each with different perspectives and
than other symptoms of the disorder. biases. Clients are key sources of information but may offer
unreliable views due to personal biases, expectations, or
People with borderline personality disorder often overreact
their psychological issues (e.g., a depressed person
to the possibility of interpersonal rejection, but is it possible
focusing only on negatives). In group therapies, like couples
that they also experience poor connectedness with others
or family therapy, differing opinions among participants
when they are being accepted and included?
may arise. Psychotherapists, though knowledgeable, can
- One study found that people with the disorder (compared also be biased. Additionally, external parties like family
to people without it) did in fact respond more negatively to members, employers, law enforcement, insurance
positive social feedback, for example, they were less companies, and society at large may have a stake in the
cooperative. therapy's results, adding complexity to evaluating its
success.
Treatment Outcome
- Research on this has a rather extensive history, with Hans
Eysenck’s unfavorable review of psychotherapy outcome Efficacy Versus Effectiveness
serving as a landmark study and a catalyst for additional
Efficacy
investigations on the subject.
- refers to the success of a particular therapy in a controlled
study conducted with clients who were chosen according
Measuring Therapy Outcome: Essential Questions to particular study criteria.
How should psychotherapy outcome be measured? - how well it works “in the lab,” where it is practiced
according to manualized methods and where outcome for
Questionnaires are an efficient and convenient method for treated individuals is compared via clinical trial with
evaluating therapy outcomes, and many commonly used outcome for individuals who receive alternate or no
measures are written surveys. However, other methods like treatment.
interviews and direct observation of clients can also be
effective. If questionnaires are the chosen method, more - Participants are often selected on the basis of meeting
specific “how” questions arise, such as the length and strict (e.g., diagnostic) criteria and are randomly assigned
format of the questionnaire. to either a treatment group or a control group.
, - In many cases, more than half of those interested in being Considering Culture
participants are excluded. Those who are included are
Treatments That Work, but for Whom?
typically less severe, more likely to have comorbid
diagnoses, and less likely to be from minority populations ❖ Muñoz and Mendelson (2005) stated, “Clinical
than are comparable clients in actual clinical settings trials have seldom included adequate samples of
people of color. Indeed, most empirically
Effectiveness
supported therapies were evaluated with samples
- refers to the success of a therapy in actual clinical settings drawn primarily from a White, middle class,
in which client problems span a wider range, and clients are English-speaking, female population”
not chosen as a result of meeting certain diagnostic criteria.
❖ Ethnic minorities simply receive less
- how well it works “in the real world,” or how well it
psychotherapy than those in the majority
translates from the lab to the clinics, agencies, hospitals,
private practices, and other settings where clinical
psychologists conduct therapy
Assessment Methods
statistical significance
Clinical psychologists conduct research to evaluate and
- is assessed quantitatively improve the assessment methods they use with clients.
Such studies may involve the development, validation, or
clinical (or real-world) significance
expanded use of new instruments; the establishment of
- is measured more qualitatively normative data for specific populations on an assessment
tool; a comparison of multiple assessment tools to one
another; or other research questions
Internal Versus External Validity Here are a few examples from the spectrum of research
being conducted in this area:
Internal validity
1. A study by Steenhuis et al. (2009) examined the
- refers to the extent to which the change in the dependent
Diagnostic Interview Schedule for Children—Version 4
variable is due solely to the change in the independent
(DISC-IV), comparing an Internet-based, self-administered
variable.
interview with a live clinician's in-person interview for
External validity diagnosing ADHD in children. The results showed a high
correspondence between both methods.
- refers to the generalizability of the result—to what extent
is the same finding valid for different settings and 2. Research by Anastopoulos et al. (2018) explored how
populations. male and female teachers and parents rate boys’ ADHD
symptoms. Female respondents provided consistently
❖ The more “controlled” and internally valid an higher ratings than males, potentially affecting diagnoses.
efficacy study is, the more dissimilar it can become
from therapy in the “real world,” thus undermining 3. Levin-Aspenson & Watson (2018) found that young,
external validity. educated adults reported fewer depressive symptoms in
❖ Efficacy studies are often respected for their interviews than on self-report questionnaires.
internal validity but discounted for their external
4. Wiebe & Penley (2005) compared English and Spanish
validity, whereas the opposite is often true for
versions of the Beck Depression Inventory-II and concluded
effectiveness studies
that the Spanish version was as reliable and valid as the
dissemination strategies English version.
- efforts to promote therapies that have demonstrated 5. Hahn (2005) tested the effectiveness of the Minnesota
effectiveness in treatment studies to large numbers of Multiphasic Personality Inventory-2 (MMPI-2) in detecting
therapists. "faking" in both North American and Korean clients. Results
indicated that the test's scales were effective in both
- Results show that therapists in clinical (as opposed to translations.
research) settings are often less than eager to accept and
use evidence-based therapies and, in some cases, are
quite resistant
