The Search for Common Factors in Psychotherapy: Two Theoretical Models with Different Empirical Implications
The difficulties of demonstrating that any specific form of psychotherapy is more effective than any other has led to the formulation of the so-called Dodo Bird Verdict (that all forms of therapy are equally effective) and to the suggestion that what really matters for therapeutic efficiency are factors that are common to different forms of therapy. The term “common factors”, however, is seldom defined in an unambiguous way. In this paper, two different models of “common factors” are differentiated, and their implications are compared. The first model is referred to as the Relational-Procedural Persuasion (RPP) model and is primarily based on the writings of Frank and Wampold; according to this model effective psychotherapy requires a good therapeutic relationship, a specified therapeutic procedure, and a rhetorically skilful psychotherapist who persuades the client of a new explanation that provides new perspectives and meanings in life. The contents of these procedures and perspectives, however, are less important – according to this model, the treatment procedures are beneficial to the client because of the meaning attributed to these procedures rather than because of the specific nature of the procedures. The other model, the Methodological Principles and Skills (MPS) model, is based on the assumption that effective psychotherapy relies on common methodological principles that are instantiated in various ways in different forms of psychotherapy, and on the therapist’s capacity of applying these principles in a skillful way. According to this model, method matters, and it is possible to improve existing methods. Whereas the MPS model carries a hope for the improvement of psychotherapy, the RPP model implies a more pessimistic view of psychotherapy as forever bound by the limits of the Dodo Bird Verdict. It is concluded that psychotherapy research may benefit from using the MPS model as a working hypothesis, but that a comprehensive model of common factors in psychotherapy also needs to integrate important insights from the RPP model, as well as an understanding of the structural characteristics that psychotherapy shares with other kinds of social interaction.
The Search for Common Factors in Psychotherapy: Two Theoretical Models with Different Empirical Implications, Psychology and Behavioral Sciences.
Vol. 3, No. 5,
2014, pp. 131-150.
Alexander, F. (1946) The principle of corrective emotional experience. In F. Alexander & T. M. French (Eds.), Psychoanalytic therapy: Principles and applications. New York: Ronald Press.
Andersen, S. M., & Berk, M. (1998). Transference in everyday experience: Implications of experimental research for relevant clinical phenomena. Review of General Psychology, 2, 81–120.
Andersen, S. M., & Przybylinski, E. (2012). Experiments on transference in interpersonal relations: Implications for treatment. Psychotherapy, 49, 370–383.
Bargh, J. A. (2006). What have we been priming all these years? On the development, mechanisms, and ecology of nonconscious social behaviour. European Journal of Social Psychology, 36, 147-168.
Bateman, A. & Fonagy, P. (2004). Psychotherapy of Borderline Personality Disorder: mentalization based treatment. Oxford: Oxford University Press.
Begg, I. M., Anas, A. and Farinacci, S. (1992). Dissociation of processes in belief: Source of recollection, statement familiarity, and the illusion of truth. Journal of Experimental Psychology: General, 121, 446-458.
Betan, E., Heim, A. K., Conklin, C. Z., & Westen, D. (2005). Countertransference phenomena and personality pathology in clinical practice: An empirical investigation. American Journal of Psychiatry, 162, 890-898.
Bowers, K. S. and Farvolden, P. (1996). Revisiting a century-old Freudian slip – From suggestion disavowed to the truth repressed. Psychological Bulletin, 119, 355-380.
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multidimensional meta-analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214-227.
Castonguay, L. G. (2000). A common factors approach to psychotherapy training. Journal of Psychotherapy Integration, 10, 263-282.
Christian, C., Safran, J. D., & Muran, C. (2012). The corrective emotional experience: A relational perspective and critique. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 51-68). Washington, DC, US: American Psychological Association.
Clarkin, J. F., Yeomans, F. E., & Kernberg, O. F. (1999). Psychotherapy for Borderline Personality. New York, NY: John Wiley & Sons.
Farber, B. A., Bohart, A. C., & Stiles, W. B. (2012). Corrective (emotional) experiences in person-centered therapy: Carl Rogers and Gloria Redux. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 103-120). Washington, DC, US: American Psychological Association.
Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20-35.
Fosha, D. (2000). The transforming power of affect: A model for accelerated change. New York: Basic Books.
Frank, J. D. (1961). Persuasion and healing: A comparative study of psychotherapy. Oxford, England: Johns Hopkins University Press.
Frank, J. D., & Frank, J. A. (1991). Persuasion and healing: A comparative study of psychotherapy. (Third edition.) Baltimore, MD: Johns Hopkins University Press.
Freud, S. (1913). On beginning the treatment (Further recommendations on the technique of psycho-analysis I). In: J. Strachey (Ed), Standard Edition of the Complete Psychological Works of Sigmund Freud (Vol. 12, p. 123-144).
Freud, S. (1916). Introductory lectures to psycho-analysis. In: J. Strachey (Ed), Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol. 15-16. London: Hogarth Press, 1955.
Freud, S. (1937). Analysis terminable and interminable. In J. Strachey (Ed.), Standard edition of the complete works of Sigmund Freud (Vol. 23, pp. 216–253). London: Hogarth Press.
Gelso, C. J. (2014). A tripartite model of the therapeutic relationship: Theory, research and practice. Psychotherapy Research, 24, 117-131.
Goldfried, M. R. (1980). Toward the delineation of therapeutic change principles. American Psychologist, 25, 991-999.
Goldfried, M. R. (2012). The corrective experience: A core principle for therapeutic change. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 13-30). Washington, DC, US: American Psychological Association.
Greenberg, L. S., & Elliot, R. S. (2012). Corrective experiences from a humanistic-experiential perspective. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 85-102). Washington, DC, US: American Psychological Association.
Hayes, A. M., Beck, J. G., & Yasinski, C. (2012). A cognitive behavioral perspective on corrective experiences. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 69-84). Washington, DC, US: American Psychological Association.
Hougaard, E. (1994). The therapeutic alliance: a conceptual analysis. Scandinavian Journal of Psychology, 35, 67−85.
Intraub, H. and Hoffman, J. E. (1992). Reading and visual memory: Remembering scenes that were never seen. American Journal of Psychology, 105, 101-114.
Kahneman, D.. A. (2011). Thinking, fast and slow. New York: Macmillan.
Kazdin, A.E. (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19, 418-428
Kiesler, D. J. (2001). Therapist countertransference: In search of common themes and empirical referents. Journal of Clinical Psychology/In Session: Psychotherapy in Practice, 57, 1053-1063.
Kilbourne, B., & Richardson, J.T. (1984). Psychotherapy and new religions in a pluralistic society. American Psychologist, 39, 237-251.
Kohlenberg, R. J., & Tsai, M. (1991). Functional analytic psychotherapy. New York: Plenum.
Kohut, H. (1984). How does analysis cure? Chicago: University of Chicago Press.
Lampropoulos, G. K. (2001). Common processes of change in psychotherapy and seven other social interactions. British Journal of Guidance and Counselling, 29, 21-33.
Lazarus, A. A. (1981). The practice of multimodal therapy. New York: McGraw-Hill.
Lilienfeld, S. O. (2007). Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53-70.
Linehan, M.M. (1993). Cognitive.behavioral treatment of borderline personality disorder. New York: Guilford Press.
Linehan, M. M. (1997). Validation and psychotherapy. In A. C. Bohart & L. S. Greenberg (Eds.). Empathy reconsidered. New directions in psychotherapy. Washington, DC: American Psychological Association.
Luborsky L., Rosenthal R., Diguer L., Andrusyna T.P., Berman J.S., Levitt J.T., Seligman D.A. & Krause E.D., The Dodo bird verdict is alive and well – mostly. Clinical Psychology: Science and Practice, 2002, 9, 2-12.
Lundh, L. G. (1987). Placebo, belief, and health. A cognitive-emotional model. Scandinavian Journal of Psychology, 28, 128-143.
Lundh, L.G. (1992). Placebo, cognition, and emotion. In W. Bongartz (Ed.) Hypnosis: 175 years after Mesmer. Recent developments in theory and application. Konstanz: Universitätsverlag, p. 151-159.
Lundh, L. G. (1998). Normal suggestion. An analysis of the phenomenon and its role in psychotherapy. Clinical Psychology and Psychotherapy, 5, 24-38.
Lundh, L. G. (2012). Non-directivity as a therapeutic stance, and dimension of therapeutic relating. Person-Centered & Experiential Psychotherapies, 11, 3, 225-239.
Matthews, W. J. (2000). Ericksonian approaches to hypnosis and therapy: Where are we now? International Journal of Clinical and Experimental Hypnosis, 48, 418-426.
McCullough, Jr, J. P. (2000). Treatment for chronic depression Cognitive Behavioral Analysis System of Psychotherapy. New York: Guilford Press.
McCullough, Jr, J. P. (2006). Treating chronic depression with disciplined personal involvement: CBASP. Richmond, VA: Springer.
McCullough, L., & Andrews, S. (2001). Assimilative integration: Short-term dynamic psychotherapy for treating affect phobias. Clinical Psychology: Science and Practice, 8, 82-97.
Öst, L. G. (2008). Cognitive-behavior therapy for anxiety disorders: 40 years of progress. Nordic Journal of Psychiatry, 62, Suppl 47, 5-10.
Perls, F. S. (1973). The Gestalt approach & Eyewitness to therapy. Palo Alto, CA: Science and Behavior Books.
Rogers, C.R. (1951). Client-centered therapy. Its current practice, implications, and theory. Boston: Houghton Mifflin.
Rogers, C. R. (1957). The necessary and sufficient conditions of therapeutic personality change. Journal of Consulting Psychology, 21, 95-103.
Rosenzweig, S. (1936). Some implicit common factors in diverse methods in psychotherapy. American Journal of Orthopsychiatry, 6, 412-415.
Ryan, R.M., & Deci, E.L. (2008). A self-determination approach to psychotherapy: The motivational basis for effective change. Canadian Psychology, 49, 186–193.
Safran, J. D., & Muran, J. C. (2006). Has the concept of the alliance outlived its usefulness? Psychotherapy, 43, 286–291.
Sandler, J. (1976) Countertransference and role-responsiveness. International Review of Psychoanalysis, 3, 43–47
Sharpless, B. A., & Barber, J. P. (2012). Corrective emotional experiences from a psychodynamic perspective. In L. G. Castonguay & C. E. Hill (Eds.), Transformation in psychotherapy: Corrective experiences across cognitive behavioral, humanistic, and psychodynamic approaches (pp. 31-50). Washington, DC, US: American Psychological Association.
Skinner, B. F. (1969). Contingencies of reinforcement. New York: Appleton-Century-Crofts.
Stopa, L. (2011). Imagery rescripting across disorders: A practical guide. Cognitive and Behavioral Practice, 18, 421-423.
Vittengl, J. R., Clark, L. A., Dunn, T. W., & Jarret, R. B. (2007). Reducing relapse and recurrence in unipolar depression: A comparative meta-analysis of cognitive–behavioral therapy’s effects. Journal of Consulting and Clinical Psychology, 75, 475–488.
Wachtel P. (1977). Psychoanalysis and Behavior Therapy. New York: Basic Books, 1977.
Wachtel, P. (1993). Therapeutic Communication. New York: Guildford Press.
Wampold, B. E. (2001). The great psychotherapy debate. Models, methods, and findings. Mahwah, N.J.; Lawrence Erlbaum Associates.
Wampold, B. E. (2007). Psychotherapy: The humanistic (and effective) treatment. American Psychologist, 62, 857-873.
Wampold, B. E., Mondin, G. W., Moody, M., Stich, F., Benson, K., & Ahn, H. (1997). A meta¬-analysis of outcome studies comparing bona fide psychotherapies: empirically, “all must have prizes”. Psychological Bulletin, 122, 203–15.
Westen, D., & Morrison, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875-899.
Wolpe, J. (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press, 1958.
Young, J. E., Klosko, J. S., & Weishaar, M. E. (2003). Schema therapy: A practitioner’s guide. New York: Guilford Press.
Zajonc, R. B. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology, 9, 1-27.