Placebo treatments in psychotherapy cannot adequately control for all common factors, which thereby attenuates their effects vis-a-vis active treatments. In this study, the authors used meta-analytic procedures to test one possible factor contributing to the attenuation of effects: structural inequalities between placebo and active treatments. Structural aspects of the placebo included number and duration of sessions, training of therapist, format of therapy, and restriction of topics. Results indicate that comparisons between active treatments and structurally inequivalent placebos produced larger effects than comparisons between active treatments and structurally equivalent placebos: moreover, the latter comparison produced negligible effects, indicating that active treatments were not demonstrably superior to well-designed placebos.

) begin to unfold, it is important to ask if these interventions can consistently demonstrate salient positive effects on levels of forgiveness and on the mental health of targeted clients.The purpose of this article is to analyze via meta-analysis the existing published interventions on forgiveness. Metaanalysis is a popular vehicle of synthesizing results across multiple studies. Recent successful uses of this method include the study by McCullough (1999), who analyzed five studies that compared the efficacy for depression of standard approaches with counseling with religion-accommodative approaches. Furthermore, in order to reach conclusions about the influence of hypnotherapy on treatment for clients with obesity, Allison and Faith (1996) used metaanalysis to examine six studies that compared the efficacy of using cognitive-behavioral therapy (CBT) alone with the use of CBT combined with hypnotherapy. Finally, Morris, Audet, Angelillo, Chalmers, and Mosteller (1992) used metaanalysis to combine the results of 10 studies with contradictory findings to show that the benefits of chlorinating drinking water far outweighed the risks. Although there may be some concern that using forgiveness as an intervention in counseling is in too early a stage of development and that too few studies exist for a proper meta-analysis, the effectiveness of these recent meta-analyses supports this metaanalytic investigation. Certainly any findings must be tempered with due caution. However, this analysis may serve as important guidance for the structure and development of future counseling studies of forgiveness.We first examine the early work in forgiveness interventions by examining the early case studies. From there, we define forgiveness, discuss the models of forgiveness in counseling and the empirically based interventions, and then turn to the meta-analysis. EARLY CASE STUDIESThe early clinical case studies suggested that forgiveness might be helpful for people who have experienced deep emotional pain because of unjust treatment. For example, Hunter (1978) reported on Harriet, a 25-year-old woman with acute emotional distress. Harriet's mother frequently condemned her daughter for the slightest deviation from her unreasonably high standards. Harriet's anger toward her mother eventually led to symptoms of anxiety and depression. In addition, she started showing such externalizing symptoms as excessive anger and frustration directed at family members. With Hunter's help, Harriet came to understand how she was reacting to her own victimization by victimizing others. In counseling, she was able to see her parents as capable of both good and bad behaviors. Forgiving her parents allowed her to take greater responsibility for her own behavior; she did not have to belittle others. Forgiving her parents allowed Harriet to experience a greater self-acceptance and to establish meaningful friendships.One of Kaufman's (1986) Thomas W. Baskin, Department of Counseling Psychology, 321 Education Building-1000 Bascom Mall, University of ...

The logic of the randomized double-blind placebo control group design is presented, and problems with using the design in psychotherapy are discussed. Placebo effects are estimated by examining clinical trials in medicine and psychotherapy. In medicine, a recent meta-analysis of clinical trials with treatment, placebo, and no treatment arms was conducted (Hróbjartsson & Gøtzsche, 2001), and it was concluded that placebos have small or no effects. A re-analysis of those studies, presented here, shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies.

No abstract

Anger and related emotions have been identified as triggers in substance use. Forgiveness therapy (FT) targets anger, anxiety, and depression as foci of treatment. Fourteen patients with substance dependence from a local residential treatment facility were randomly assigned to and completed either 12 approximately twice-weekly sessions of individual FT or 12 approximately twice-weekly sessions of an alternative individual treatment based on routine drug and alcohol therapy topics. Participants who completed FT had significantly more improvement in total and trait anger, depression, total and trait anxiety, self-esteem, forgiveness, and vulnerability to drug use than did the alternative treatment group. Most benefits of FT remained significant at 4-month follow-up. These results support FT as an efficacious newly developed model for residential drug rehabilitation.