Browsing by Subject "psykoterapeutti"
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(2022)Aims. Clinical errors cause a significant number of deaths both in the field of medicine and clinical psychology, hence being a major threat to patient safety. One explanation behind clinical errors is heuristic thinking which affects decision-making automatically and aims for a result that is sufficient enough. Heuristic thinking can also lead to cognitive biases which affect decision-making by distorting interpretations of observations. The clinical errors caused by physicians have been studied far more than those caused by psychologists and psychotherapists. However, research has shown that a clinical error, such as a diagnostic mistake or unsuitable therapy method, affects the treatment of every fifth psychiatric patient. Thus, the main aim of this literature review was to investigate which heuristics and biases affect therapists’ decision-making and through which mechanisms they affect. In addition, the review examined which characteristics related to the therapist, patient and situation predispose to the adverse effects and how these effects could be minimized. Methods. The literature for this review was retrieved from the databases of Helsinki University Library and Google Scholar with the search statement (heuristic* OR bias*) AND (clinical reasoning OR clinical decision* OR clinical judgement). The search was limited to articles published between 2015-2022, but some previously published articles found in the references and the older original editions of the most influential papers were also used. Results and conclusion. This review showed that spending an insufficient amount of time with the case evidence, being too inflexible, therapist’s emotional reactions and false beliefs of their competence are strongly related to the adverse effects of cognitive biases and heuristics. This review also identified that the characteristics of patients, like their ability to cooperate, and the complexity of situations also affect the quality of clinical decisions. In addition, this review showed that it is possible to minimize the adverse effects by participating in training that focuses on these effects, using a patient-therapist feedback system, and keeping the mechanisms through which biases and heuristics affect consciously in mind when making decisions. These strategies should be implemented as quickly as possible to ensure safety and health equality.
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(2017)Objective The aim of this bachelor thesis is to investigate how duration of psychotherapy affects it´s outcome when treating adults with unipolar depression. So far the scientific evidence in this matter has been patchy: very few meta-analyses or systematic reviews have been published and thus there is no clear consensus in the field. Methods This bachelor thesis was carried out as a literature meta review. Effectiveness studies of both short and long term psychotherapies were included, along with studies that focus specifically on the length of therapy. There were two inclusion criteria for the studies: at least half of the subjects were required to have unipolar depression as their main psychiatric problem, and no specialty groups – such as pregnant women or ethnical minorities – were allowed as a main sample. Results and implications Among short term (1-20 sessions) psychotherapies, scientific evidence for optimal therapy duration is conflicting. It is, however, safe to say that the shortest (1-3 sessions) psychotherapies are the least effective therapeutic interventions of all kinds. Change during psychotherapy was roughly linear across all studies and initial symptom severity did not correlate significantly with optimal length of psychotherapy. Long psychotherapies of over 100 sessions proved to be the most effective. However, there are only few effectiveness studies investigating long-term psychotherapies and the methodology of those studies is not only varied but often quite lenient. Therefore it is dubious to compare short- and long-term psychotherapies and these results should be taken as preliminary remarks. There are practically no studies investigating medium long (20-100 sessions) psychotherapies. Given the scientific evidence, psychotherapeutic guidelines in Finland seem rather weird. In Finland, most therapies last 100-200 sessions, although good quality studies supporting these kinds of treatments are still sparse. On the other hand, short term psychotherapies are still rather rare in Finland despite firm scientific evidence suggesting their high utility in everyday clinical practice.
Now showing items 1-2 of 2