An important result for therapy research and perhbaps a solution

This is an interesting chapter of a book.
http://books.google.co.uk/books?hl=en&lr=&id=jEtD2YFC5XoC&oi=fnd&pg=PA17&ots=E1z24-vgVV&sig=X_azXuEw_mIjcxF4N3gANJNbOS0#v=onepage&q=&f=false
<http://books.google.co.uk/books?hl=en&lr=&id=jEtD2YFC5XoC&oi=fnd&pg=PA17&ots=E1z24-vgVV&sig=X_azXuEw_mIjcxF4N3gANJNbOS0#v=onepage&q=&f=false>

Here's a summary from some information a friend of mine sent me that led
me to this paper.
"The reality is that the material is a small part of the equation - the
teacher is nearly everything - as is the willingness of the pupil to
learn, and how supportive his or her parents are. And it's a similar
picture in therapy. The attached diagram was created by Lambert,
Norcross and others, on the basis of a meta-analyses of therapy
research, to show the factors that have the biggest impact on therapy
outcomes. It shows that:

40% of improvement in therapy is attributable to factors that are PART
OF THE CLIENT (e.g. personality, circumstances, social support,
fortuitous events)
30% is attributable to 'common factors' - i.e. things that ALL therapies
have in common such as talking, empathy, regularly meeting with another
person etc
15% is attributable to the placebo effect - i.e. the expectancy that it
will work
15% is attributable to the specific techniques used "

The last line is the most interesting. For all the research and clever
thinking that goes into measuring the effectiveness of psychological
therapies the small amount of potential for variance is measured and the
more important aspects, such as a good therapeutic alliance, seem to be
ignored in commissioning.

Psychological therapies should look to match client with therapist first
and apply whatever technique is considered best as the next treatment
decision. I question the latter because I personally feel that the
majority of research in psychological therapies is flawed and has small
effect sizes so its better to offer a spectrum of options and trials of
different therapy and therapists.

Its expensive but another friend of mine suggested a way that it could
be done. Tele-therapy, specifically using VoIP and video calls, could
create new PT call centres to manage the mental health of the nation
empowered by digital information. Frankly I consider ths not a great
solution because it still lacks the importance of physical presence,
full body language communication between client and therapist and the
opportunity for physical contact. "*hugs*" aren't enough when a person
needs a hug.

It would make sense because these therapy farms would be cheaper to run
and "battery farmed" (mass produced) therapists could be trained for low
severity interventions. I think the cost benefits would outweigh the
need for high quality therapists and the understanding that battery
farmed therapists are more likely to be the bad ones that produce poor
outcomes than "organic" therapists. The more skilled therapists could be
reserved for face to face, high severity conditions or complex
conditions. They can also provide "second line support" to escalate
difficult problems or to help if a therapeutic intervention by a
battery-farmed therapist goes awry.

Telemedicine is a prospect for the future and its just a matter of time
before going to see the doctor is as convenient as making a phone call.
This solution does have the benefit of offering more opportunity to chop
and change therapists and avoid being put to the end of the waiting list
and a number of other benefits, e.g. access to notes from other therapists.

Its not such a crazy idea. Employee assistance programs have already
being providing therapy over the phone and recent developments in NHS
mental healthcare have seen some experiments with telephone-based
services. The addition of video is an important one because, in my
opinion, correct communication is essential and body language is a large
part of that. Call centres are already moving towards providing video
call services and there will be contact logging software that integrates
with the VoIP systems so there's no need to create bespoke software to
handle the data. Middleware applications could provide the interface
with patient medical records however as far as I am aware these are
rarely used by therapists but I'm not sure about that. Of course the UK
is in the dark ages when it comes to electronic medicine and electronic
patient records are a long way off so the element of integration with
current record systems is moot.