American Psychological Association, Bruce Thyer, Bruce Wampold, common factors psychotherapy, DoDo Bird Verdict, Evidence-Based Practice, Monica Pignotti, Practice-Based Evidence, psychologists, psychotherapy, Social Work, society for social work research
Therapy Clients/Patients and Therapists: Your Responses Invited
Last weekend, I attended the annual conference of the Society for Social Work Research (SSWR) in Tampa, Florida. One of the most interesting and provocative sessions I attended was a roundtable session and discussion on Evidence Based Practice versus Practice Based Evidence (note: Allen Rubin was not present at this session, as listed on the program but all the others listed were). The common factors approach to psychotherapy and the DoDo Bird Verdict were being discussed. The DoDo Bird Verdict is basically the idea that there are no major differences between various therapies and thus, it makes no difference which interventions are chosen and that the most important common factor in therapy is the quality of the relationship between the client and therapist. This notion is based on the results of a number of published meta-analyses that have purported to statistically demonstrate this. However, this is highly debatable and controversial because the methodology of these meta-analyses has repeatedly been called into question and there are, of course, a number of studies that do show robust differences between specific interventions for specific types of problems. Nevertheless, that is the point of view that was being presented by proponents of Practice Based Evidence and the DoDo Bird Verdict. It is called that after the DoDo bird in Alice in Wonderland, who said “Everybody has won and all must have prizes.”
One of the findings in common factors research is that clients do better with theoretical approaches that are consistent with their own worldview and hence, therapists should present explanations about why a particular approach being offered that are consistent with the client’s worldview, even if that explanation lacks scientific support and there are better supported explanations that are not consistent with the client’s worldview and even if the therapist is aware that the explanation is not the scientifically correct one (this is my understanding — proponents can feel free to correct me if I have gotten anything wrong in my paraphrase).
One of the panel participants, Bruce Thyer, offered and challenged the following quotes, from an article published in the journal, American Psychologist, by psychologist Bruce Wampold, who is one of the most prominent proponents of the common factors approach. Without further comment, I would be very interesting in hearing responses anyone reading this has to the following quotes from that article:
I argue here that the truth of the explanation is unimportant to the outcome of psychotherapy. The power of the treatment rests on the patient accepting the explanation rather than on whether the explanation is “scientifically” correct…What is critical to psychotherapy is understanding the patient’s explanation of it (i.e. the patient’s folk psychology) and modifying it to be more adaptive.” (Wampold, 2007, p. 974, American Psychologist (November). Psychotherapy The Humanistic (and Effective Treatment. (pp. 857-984)
I hypothesize that effective explanations in psychotherapy must be different from presently held explanations for a patient’s troubles but not sufficiently discrepant from the patient’s intuitive notions of mental functioning as to be rejected…Effective therapists are skilled at monitoring acceptance of the explanation and will modify the delivery of an explanation as necessary. (Wampold, 2007, p. 975, American Psychologist (November). Psychotherapy The Humanistic (and Effective Treatment. (pp. 857-984)
I will offer my own comments and opinions later, but would very interested in any reactions readers might have to this, particularly if you are, or have ever been a therapy client or if you are a therapist. How would you feel about a therapist taking this approach with you? Would you rather hear the scientifically correct explanation that best approximates what we currently know according to evidence or the explanation that is most compatible with your own belief system, even if not scientifically correct and even if it went against evidence? I would be very interested in any reactions anyone has to these statements.