Downloaded by [New York University] at 03:56 14 August 2016 the Great Psychotherapy Debate

Downloaded by [New York University] at 03:56 14 August 2016 The Great Psychotherapy Debate The second edition of The Great Psychotherapy Debate has been updated and revised to expand the presentation of the Contextual Model, which is derived from a scientifi c understanding of how humans heal in a social context and explains fi ndings from a vast array of psychotherapy studies. This model provides a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specifi c ingredients of treatment. The new edition also includes a history of healing practices, medicine, and psychotherapy; an examination of therapist effects; and a thorough review of the research on common factors such as the alliance, expectations, and empathy. Bruce E. Wampold , PhD, ABPP, is the Patricia L. Wolleat Professor of Coun- seling Psychology at the University of Wisconsin–Madison and director of the Research Institute at Modum Bad Psychiatric Center in Vikersund, Norway. Zac E. Imel , PhD, is an assistant professor with the counseling psychology program in the department of educational psychology and an adjunct assistant professor in the Department of Psychiatry at the University of Utah. Downloaded by [New York University] at 03:56 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:56 14 August 2016 The Great Psychotherapy Debate The Evidence for What Makes Psychotherapy Work Second Edition Bruce E. Wampold and Zac E. Imel Downloaded by [New York University] at 03:56 14 August 2016 Second edition published 2015 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 27 Church Road, Hove, East Sussex BN3 2FA Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Bruce E. Wampold and Zac E. Imel The right of Bruce E. Wampold and Zac E. Imel to be identifi ed as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice : Product or corporate names may be trademarks or registered trademarks, and are used only for identifi cation and explanation without intent to infringe. First edition published by Routledge 2001 Library of Congress Cataloging-in-Publication Data Wampold, Bruce E., 1948– The great psychotherapy debate : the evidence for what makes psychotherapy work / by Bruce E. Wampold and Zac E. Imel. — Second edition. pages cm Includes bibliographical references and index. 1. Psychotherapy—Philosophy. 2. Psychotherapy—Evaluation. I. Imel, Zac E. II. Title. RC437.5.W35 2015 616.89′14—dc23 2014032867 ISBN: 978-0-8058-5708-5 (hbk) ISBN: 978-0-8058-5709-2 (pbk) ISBN: 978-0-203-58201-5 (ebk) Typeset in Baskerville by Apex CoVantage, LLC Downloaded by [New York University] at 03:56 14 August 2016 To all of my collaborators, personal and professional, many of whom have made sacrifi ces so that this revision could be completed. BEW To KT, Jiajia, and Lulu. ZEI Downloaded by [New York University] at 03:56 14 August 2016 This page intentionally left blank Downloaded by [New York University] at 03:56 14 August 2016 Contents Preface viii 1 History of Medicine, Methods, and Psychotherapy: Progress and Omissions 1 2 The Contextual Model: Psychotherapy as a Socially Situated Healing Practice 37 3 Contextual Model Versus Medical Model: Choosing a Progressive Research Programme 62 4 Absolute Effi cacy: The Benefi ts of Psychotherapy Established by Meta-Analysis 82 5 Relative Effi cacy: The Dodo Bird Still Gets It 114 6 Therapist Effects: An Ignored but Critical Factor 158 7 General Effects: Surviving Challenges and Anticipating Additional Evidence 178 Downloaded by [New York University] at 03:56 14 August 2016 8 Specifi c Effects: Where Are They? 213 9 Beyond the Debate: Implications of the Research Synthesis for Theory, Policy, and Practice 255 References 279 Index 317 Preface When one publishes a book with the word debate in the title, one must be pre- pared for rebuttals. In science, rebuttals are best presented as evidence. In the 13 years since the fi rst edition, there have been many arguments about what makes psychotherapy work, best characterized by a debate between proponents of evidence-based treatments and proponents of common factors. This debate often mischaracterizes one side or the other, with more than a few instances when rhetorical accusations have predominated, rather than evidence. Rhetoric does not keep me up at night but evidence surely does. And since the fi rst edition, there have been many reasons for sleepless nights. As Zac and I discuss in this volume, psychotherapy evidence has proliferated since the fi rst edition. The number of psychotherapy clinical trials and meta-analyses of these trials has increased exponentially. There is more evidence now for the effectiveness of psychotherapy than ever before. Would that evidence trend toward showing the scientifi c folly of the Contextual Model that I proposed in 2001? If so, then the Contextual Model would fall on the scrap heap of perfectly rational, but empirically unsupported, theories, including chemical theories of fermentation (spontaneous generation), light propagation through aether, and a static universe (Einstein’s Universe). Yet, the research conducted in the last decade and a half has not produced evidence that seriously threatens the Contextual Model—indeed, the evidence for the Contextual Model is an order of magnitude stronger than it was in 2001. In the preface to the fi rst edition I spoke about the meaning of psychotherapy for me personally and dedicated the book in part to my therapist. Sadly, Downloaded by [New York University] at 03:56 14 August 2016 some have used this intimate story to say that my work is biased and should not be trusted. So, let me be clear about this—as is true of all humans, I do indeed have biases. However, one hallmark of science is that we intentionally put our biases aside and attend rationally to evidence. Moreover, the scientifi c endeavor is a correcting system in that evidence in the end will prevail and theories will be abandoned, despite their ability to attract adherents, should the evidence be suffi ciently compelling. As with all theories, the current iteration of the Contextual Model will be modifi ed as anomalies are detected—in the coming decades, evidence will likely emerge that both clarifi es and complicates Preface ix components of the model. In this process, my allegiance is to the evidence and there is no disgrace in having one’s theory ultimately to be found in the same dustbin as Einstein’s Static Universe. This edition of The Great Psychotherapy Debate differs from the fi rst edition in several ways. Of course, the research corpus is updated and the various chapters refl ect the latest evidence. The fi rst chapter now presents a brief history of medicine and psychotherapy to put the current debate into proper perspec- tive. In 2001, the Contextual Model I proposed was just emerging from the work of Jerome Frank. During the last decade, the model has expanded based on social science research—the expanded model is presented in Chapter 2. As in the previous edition, there is a chapter ( Chapter 3 ) that presents what evidence is to be considered and then discusses the conjectures of the Medical Model and the Contextual Model. As in the fi rst edition, there are chapters that examine the evidence for absolute effi cacy ( Chapter 4), relative effi cacy (Chapter 5 ), and therapists’ effects ( Chapter 6 ). In the fi rst edition, evidence related to general effects was limited to a discussion of the therapeutic alliance. We have expanded this section to also include how placebos induce powerful expectations, as well as several other therapeutic factors hypothesized to be powerful in the Contextual Model ( Chapter 7 ). Chapter 8 reviews the literature on the importance of specifi c ingredients. Chapter 9 makes conclusions related to theory, practice, and policy. Books have authors. But authorship refl ects an amalgamation of infl uences. To a large extent, my work was spawned from discussions with students and collaborations with colleagues around the world. Zac Imel, from his fi rst days as my doctoral advisee over a decade ago, has challenged me to think deeply about the issues discussed in this edition and expand my methodological exper- tise. He would bring articles and books to me: “You have to read this!” and “We have to learn new methods to understand this issue,” his restless mind collect- ing and synthesizing information from a variety of spheres. This edition has continued our intellectual collaboration, mutually stimulating and rewarding. BEW, Madison, Wisconsin, April 1, 2014 Quite unintentionally, my psychology training began in small groups that were a part of church youth camps in the Red Rock Canyons of Oklahoma. I Downloaded by [New York University] at 03:56 14 August 2016 observed the work of talented group leaders who worked to replace emptiness and shame with acceptance and support. While many of my peers were taken with spiritual explanations for these experiences, in me they awoke an apprecia- tion for open and emotionally charged relationships and provided an enduring template that continues to guide my relationships and inform my clinical work. The intervention we discuss in this book is still mostly a human conversation— perhaps the ultimate in low technology.

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