HOW EFFECTIVE IS THE HOME-BASED APPROACH?
RESEARCH ON PHONE AND COMPUTER-ASSISTED THERAPY
The six studies below display evidence for the efficacy of these approaches.
- Grumet (1979) found visual privacy afforded by the phone allows the reluctant patient to achieve closeness at a distance. Of particular importance is that he noted that those who feel shame and embarrassment, like so many we encounter, were better able to approach it without seeing their therapists facial reactions. (For centuries Catholic priests have encouraged honest confession with this practice. It can be noted that Freud sat behind his patients in order to not let his presence distract his patients from their innermost feelings and thoughts.) Grumet also found many patients to be less inhibited when at ease at home.
- Swingson, Cox and Wickwire (1995) found phone therapy cost-effective and an efficacious treatment approach for agoraphobics living in remote regions where specialized anxiety disorder services were not available.
- Lester (1995) did follow up studies of phone counseling in which callers were asked to evaluate the service. The majority of callers were satisfied and listed several helpful (telephone) behaviors of their therapists in the process.
- Biggs (2004) surveyed 44 who had received sex therapy over the Internet. Eighty percent said they found the experience “somewhat or very positive”. All said they “wound use it again.”
- Ludman (2007) found that depressed patients who got 10-12 phone therapy sessions per year, in addition to standard depression care, showed greater improvement than those who did not have phone therapy.
- Carroll (2008) in a Yale study published in the May 1 American Journal of Psychiatry used computer-assisted training in addition to traditional counseling as compared with only traditional for drug users. She found the computer-assisted group stayed abstinent significantly longer. The researchers used Cognitive-Behavioral therapy which concentrates on teaching skills and strategies to change behavior patterns. “At first glance computer-based training may appear to threaten the conventional patient-therapist relationship,” stated one professor. “However, I see it as a demonstration of how a low cost but carefully conceived procedure can enhance treatment and add additional elements of richness and effectiveness to its power.”
A PRACTICAL COMPARISON BY EXAMPLE
When compared with the actual process of traditional therapy, each therapist will first typically address the initial issue of denial. This will happen whether the approach is traditional face-to-face (in the office) or by voice-to-voice (over the phone). In both modalities the types of denial and identification of the patients own form of denial are addressed. Both modalities require the patient to confront his denial and learn how to change it. Accountability for changed thinking and behavior is the same. In short, the bottom line outcome and goals are effectively the same.
EVIDENCE FOR COGNITIVE-BEHAVIORAL TREATEMENT
The evidence-based research documented below shows the efficacy of the Cognitive-Behavioral approach. CBT is without question the most widely accepted approach today.
The Home-based System is based on experience and data from three treatment approaches: 1) Cognitive-Behavioral Therapy, 2) Task-Oriented Therapy, and 3) Relapse Prevention (RP).
1. Cognitive-Behavioral Therapy
- Marshall’s work in Canada, (“Cognitive Behavioral Treatment of Sexual Offenders”, Marshall, Anderson, Fernandez, 2006) cites throughout the empirical basis for applying the Cognitive/Behavioral approach. Numerous other studies cite the effectiveness of Cognitive-Behavioral strategies in treating compulsive sexual behavior. (Antonowicz and Valliant, 1992, Hanson, R.K., 2002, et al.)
- In Relapse Prevention With Sex Offenders, Laws (1989) describes three state programs successfully using similar relapse prevention and cognitive-behavioral techniques to those used in this program.
- R.K. Hanson, Gordon, A. et al. (2002) as reported in Sexual Abuse: A Journal of Research and Treatment, 14 (2), 169-194, stated in their meta-study of various treatments that “The treatments that appeared effective were cognitive-behavioral for adult sexual offenders…offenders who failed to complete treatment, regardless of the type of treatment they attended, had a higher recidivism rate.”
Note: study after study has proven treatment works as compared to no treatment at all, with the improvement ratio most often in the range of 2 to1. This fact negates a myth that treatment does not make a difference. The fact is that it clearly does make a significant difference.
2. Task-Oriented Therapy
When the goal is specific behavior change, active participation in doing tasks is the most effective approach. Carnes study of the effectiveness of his task-oriented approach with sex addicts yielded an 87% recovery rate for all who finished his three-year, thirty-task system to change compulsive sexual behavior (1983, 1991). Carnes studies displayed what he calls “a predictable process of recovery, with its own stages of development, milestones of progress, and tasks to accomplish”. This has been proven in behavior therapy and by numerous 12 Step programs that require active step work. The client is forced to consider issues and decisions that he would otherwise bury within himself. Among other advantages, finishing the task (and level of effort therein) evidences clearly the motivation of the patient, and eliminates “players”.
3. The Relapse Prevention (RP) Model
In the criminal justice system, Herman (1988) wrote, “a model of addiction offers clear guidelines for the development of offender treatment program programs”. Schwartz and Masters research (1994) notes “because the factors that etiologically contribute to hypersexual behavior cause compulsivity symptoms, while addictive cycles maintain and perpetuate the behavior, effective treatment requires integration of trauma-based approaches to addictive behavior with cognitive behavior models”. In simple terms, integrating Relapse Prevention is a virtual requirement in dealing with this population effectively.
COMPARING GROUP AND INDIVIDUAL APPROACHES
One-to-one therapy is a strong adjunctive to Group Therapy. Both augment each other. Individualized therapy can achieve personal goals that group therapy alone does not address. For example, discussion of sexual and other intimate issues is best provided in an on-going series of individual sessions where interpersonal trust is established. It provides many “group reticent” males a confidential environment for private disclosure of intensely intimate issues, e.g. such as fantasy thinking (normal and deviant). Sexual abuse and shame from intense or traumatic childhood events are most effectively dealt with in a one-to-one setting.
Groups do not provide this type of individualized tailoring based on clients needs. Most therapists agree that optimal results are produced when both group and individual settings are combined in a two-pronged therapeutic approach.
There are additional therapeutic advantages to the Home-Based System. Doing “therapeutic tasks” at home enables deeper reflection because the patient has ample time and opportunity to identify and to “own” out of control sexual patterns. In the sexual dimension, such intra psychic patterns can be acutely private and sensitive. For example, in Session Two: The Arousal Cycle, a patient is required to learn about and identify his “own” arousal protocol or sequence. This responsible “ownership” is crucial to meaningful change.
The therapeutic task, reflected upon and processed at home, requires the patient to confront keenly personal issues. Why? He knows sliding through is not possible because he will be addressing them directly with his exacting therapist in their very next session.