Stephen M. Saunders, Ph.D., Associate Professor and Director of Clinical Training, Department of Psychology, Marquette University
The Mental Health Services Research Laboratory comprises various research projects that evaluate some aspect of the mental health services system. The system comprises patients, therapists, evaluations, interventions, and any research on any of these aspects.
The service system is broadly divided into three interrelated aspects: treatment seeking, treatment reception, and treatment outcome. Our lab is investigating all of these.
People enter the service system only after a series of decisions (see Saunders & Bowersox, 2007). First, a person must recognize (or perhaps someone has decided for the person) that he or she has a problem. After that, the person must recognize or decide that the problem is related to mental health, rather than to some physical health problem (“I have a blood disease that doctors have not diagnosed correctly”) or some situation over which they exert no control (“It’s my wife’s fault I drink too much!”).
Subsequently, the person must then decide whether something can and should be done, by herself, to alleviate the problem. Many people don’t; they simply continue to suffer and perhaps cause for others emotional distress. They may believe that the situation cannot be changed, or that treatment cannot help, or they may simply not be distressed or impaired enough to feel treatment is necessary. If the person does decide that things need to change, he or she then must decide that professional treatment is necessary. Of course, at this step, the person may decide to engage in some self-help effort, which can be successful (as many former alcoholics can attest).
After deciding that professional treatment is necessary to effect needed change, the person must decide what treatment will be pursued. The main decision here is whether to opt for biological (medic) or psychological (psychotherapy) interventions. It might not surprise the reader to learn that I have a strong bias towards psychological interventions. Unfortunately, the drug industry spends hundreds of millions of dollars every year to promote the idea that all emotional distress—even that caused by severe abuse or trauma—is a problem of brain chemistry that should be solved by drugs.
Finally, the person makes and keeps an appointment. This is not guaranteed, even if the person decides that professional treatment is necessary to effect change that is necessary. Many people will make an appointment but not keep it (the so called “no show” problem).
Our research lab has conducted and has underway numerous studies of treatment-seeking.
Once a person has made it into the office of a mental health professional, the phase of treatment reception begins. During this phase, the person either accepts that treatment will be potentially helpful and subsequently engages in it. Several things need to happen relatively early in treatment to promote patient receptivity.
First and foremost, the patient must come to believe that the professional has the capacity and wherewithal (i.e., skill) to help. This comprises several aspects. First, the patient must come to believe that the professional understands what is going on. This is the issue of empathic understanding. A therapist needs to communicate understanding of the patient’s environment as well as of her emotional, cognitive and behavioral states. Second, the patient must perceive that the therapist is being sincere or true to himself. This is the issue of genuineness, and this enables the patient to trust what the therapist says or recommends. Finally, the patient must believe that the therapist—despite all of the patient’s self-perceived faults—likes and cares about the patient. This is the concept of unconditional positive regard. These three parts constitute the emotional bond part of the therapeutic alliance, which is sometimes called the working alliance or the therapeutic relationship.
In addition, the patient must come to see that treatment is consistent with his or her world view or general attitude towards self, others and life. Essentially, the patient must understand and agree with (1) what happens during therapy sessions and (2) what therapy is trying to accomplish. These are the tasks and goals of psychotherapy. If a patient doesn't understand what is happening during the session or why it is happening, then treatment will not be well received. For example, if a patient is expecting that treatment will entail drug treatment, he will likely not be receptive to psychotherapy. Another patient expecting treatment to be replete with therapist suggestions and advice will probably be disappointed by a therapist who is nondirective.
One of the main focuses of recent research in the lab has to do with spirituality. We take the perspective that religious and spiritual beliefs are an essential and very important aspect of most patients' lives, and we are investigating the role of attending to such issues during treatment.
Our research lab has conducted and has underway numerous studies of treatment reception.
Treatment will hopefully be sought and received by patients. It will also hopefully be effective. The measurement and documentation of treatments effects has been one of the major scientific pursuits of psychology of the last 50 years, ever since Hans Eysenck declared that psychotherapy was no more effective than the passage of time.
Also, numerous research labs around the country are evaluating the effects of specific treatments such as cognitive therapy studies of the effects of specific treatments are usually called "efficacy" studies. These studies are usually conducted as experiments at research facilities. In our lab, we focus on "effectiveness" studies, as we try to determine the effects of treatment as conducted in the community. We have done studies of the therapeutic alliance as a determinant of outcome, and studies of how best to measure outcome in community settings. For example, we try to implement brief, easy-to-understand and easy-to-administer measures that can be readily used in community-based clinics. We are currently studying the usual response of patients to treatment.
Our research lab has been involved in numerous projects regarding the measurement of treatment outcome.