Chapter 18: Exercises

Comprehension Check

1. Summarize the meta-analytic evidence for therapy effectiveness. What are the typical effect sizes, and how do they compare to medical treatments?

2. Explain the dodo bird verdict. Under what conditions does it hold, and when does it break down?

3. What is the therapeutic alliance, and why is it one of the strongest predictors of therapy outcome?

4. Describe three key differences between therapy as represented on TikTok and evidence-based therapy practice.

5. List five possible reasons therapy might not be working for a specific client. Which are about the client, and which are about the treatment or circumstances?

Application

6. Research three therapeutic approaches (CBT, psychodynamic therapy, EMDR). For each, find: - What conditions it is evidence-based for - The approximate effect size from meta-analyses - Whether it's recommended by NICE or APA guidelines

7. If you've been in therapy, reflect: was the approach evidence-based for your specific concern? Did your therapist discuss treatment goals and track progress? If not, what does this chapter suggest you might do differently?

8. Find three therapy-related TikTok or Instagram accounts. Compare their content to the evidence-based therapy characteristics described in this chapter. What's similar? What's different?

9. The chapter states that therapist effects (5–8% of variance) are larger than therapy type effects (~1%). Design a system that would help therapy consumers identify effective therapists. What would it look like? What barriers would it face?

10. Apply the toolkit to the claim: "Everyone should be in therapy." What does the evidence say about who benefits most from therapy, and are there situations where therapy might not be the best first-line intervention?

Critical Thinking

11. If the therapeutic alliance predicts outcomes more than the specific approach, does this mean therapist training should focus more on interpersonal skills and less on specific therapy techniques? What would be lost?

12. The chapter notes that most therapists don't track their outcomes systematically. Why not? What cultural, practical, and psychological barriers prevent outcome tracking in therapy?

13. TikTok therapy emphasizes validation and insight; evidence-based therapy emphasizes skills and behavior change. Is there a way to combine both? Or does the emphasis on validation undermine the mechanism of change?

14. The dodo bird verdict says different approaches produce similar outcomes. But for OCD and PTSD, specific approaches are clearly superior. How should clients be informed about when the specific approach matters and when it doesn't?

15. If therapy has a 50–65% response rate, that means 35–50% of clients don't improve substantially. Should this rate be communicated to clients at the start of therapy? What are the risks and benefits of transparency about response rates?

Fact-Check Portfolio

16. If any of your 10 claims involve therapy, counseling, or mental health treatment: - Does the claim specify which type of therapy? - Does it distinguish between evidence-based and non-evidence-based approaches? - Does it account for therapist quality? - Update your evidence rating.