What do therapeutic approaches look like? - Chapter 3

Why is the effectiveness of therapy differential?

Certain therapies are better (more suitable) for certain types of psychological stress. It is therefore important to identify the specific problem of an individual. Then, it is best to look for the most effective form of therapy. Empirically supported interventions are therapeutic applications, of which the effectiveness for certain client groups has been demonstrated by rigorous experimental studies.

The effectiveness of cognitive, behavioral and cognitive-behavioral therapies has also been demonstrated for a wide range of psychological difficulties. In contrast, other approaches (such as psychodynamic therapy) are only effective for a number of psychological difficulties. Furthermore, existential therapy has not proven to be effective for any psychological difficulty.

What criticism is there on empirically supported treatments?

The concept of empirically supported treatments is based on the assumption that discrete forms of psychological disorders exist. However, many researchers do not (completely) agree with this assumption. For example, they state that there is often an overlap between symptoms of psychological disorders. Research shows that fifty to ninety percent of individuals with a mental disorder also meet the criteria for one or more other disorders. This is called comorbidity. So, there is a diagnosis of more than one form of severe psychological stress in an individual at the same time.

Another problem is that the research that forms the basis of the empirically supported treatments is based on certain samples. Generalizing these samples to the population should be done under extreme caution. For example, the ethnicity of the sample versus that of the population should be taken into account. Furthermore, certain individuals are systematically excluded from controlled studies. Examples of this are individuals with comorbid diagnoses, pharmacological treatments or a high suicide risk. Thus, generalizable effectiveness for this group of individuals is difficult to find or demonstrate.

Furthermore, the absence of a particular therapy from the list of empirically supported treatments does not always mean that this therapy has been shown to be ineffective. It may also mean that the effectiveness of this therapy has not yet been studied!

Another problem is the researcher 's loyalty problems. This is the tendency of researchers to 'find' or 'look' for results that support their own beliefs, expectations or preferences. This does not mean that researchers consciously or intentionally manipulate their research results, instead this is more an unconscious process.

What is meant by the 'dodo bird verdict'?

Control "therapies" are often performed by non-dedicated practitioners with little training and experience. They are often implicitly or explicitly linked to experimental therapies. These practitioners are often unintentionally inclined to validate the experimental hypotheses. Despite this potential bias, research shows that control 'therapies' can certainly be effective, as are placebo conditions.

The dodo bird verdict is the claim that different bonafide therapies are approximately equivalent to each other when it comes to efficacy and effectiveness.

Bonafide therapy is a therapeutic application that is carried out in good faith. The practitioner is trained and committed, and the application is based on solid principles.

Nonspecific/corresponding factors are the aspects of the therapeutic process that are consistent with therapeutic relationships. Specific / model factors are well-defined therapist actions associated with a particular therapeutic approach.

What basis do differential effectiveness and the dodo bird verdict share?

The debate between differential effectiveness and the dodo bird verdict could go on forever. How do we determine which perspectives and research results are favorable for the therapist and the client and which are not? It is good to assume that both non-specific and specific factors can contribute to psychological change. Lambert's research shows that nonspecific factors account for about eighty-five percent of the variance of therapeutic outcomes. Thus, fifteen percent of the variance can be attributed to the therapist's specific techniques or model.

The aptitude-treatment interaction (ATI) paradigm refers to the assumption that clients with certain qualities and characteristics will improve more in certain types of therapies.

Chapter questions

1. What are empirically supported treatments?

2. What is comorbidity and how often does it occur?

3. What is the dodo bird verdict?

4. What does Lambert's research show?

5. What is the treatment fitness interaction paradigm?