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Maximizing Effectiveness in Dynamic Psychotherapy Self-Compassion in Psychotherapy101 Healing StoriesA Clinician's Guide to Legal Issues in PsychotherapyA Map of the MindA Primer for Beginning PsychotherapyACT With LoveActive Treatment of DepressionAffect Regulation, Mentalization, and the Development of SelfAlready FreeBad TherapyBecoming an Effective PsychotherapistBecoming MyselfBefore ForgivingBeing a Brain-Wise TherapistBetrayed as BoysBeyond Evidence-Based PsychotherapyBeyond MadnessBeyond PostmodernismBinge No MoreBiofeedback for the BrainBipolar DisorderBody PsychotherapyBoundaries and Boundary Violations in PsychoanalysisBrain Change TherapyBrain Science and Psychological DisordersBrain-Based Therapy with AdultsBrain-Based Therapy with Children and AdolescentsBrief Adolescent Therapy Homework PlannerBrief Child Therapy Homework PlannerBrief Therapy Homework PlannerBuffy the Vampire Slayer and PhilosophyBuilding on BionCare of the PsycheCase Studies in DepressionCaught in the NetChild and Adolescent Treatment for Social Work PracticeChoosing an Online TherapistChronic DepressionClinical Dilemmas in PsychotherapyClinical Handbook of Psychological DisordersClinical Intuition in PsychotherapyClinical Pearls of WisdomCo-Creating ChangeCognitive Therapy for Challenging ProblemsCompassionConfessions of a Former ChildConfidential RelationshipsConfidentiality and Mental HealthConfidingContemplative Psychotherapy EssentialsControlConversations About Psychology and Sexual OrientationCoping with BPDCouch FictionCounseling in GenderlandCounseling with Choice TheoryCouple SkillsCrazy for YouCreating a Life of Meaning and CompassionCreating HysteriaCritical Issues in PsychotherapyCrucial Choices, Crucial ChangesDeafness In MindDecoding the Ethics CodeDeconstructing PsychotherapyDeep Brain StimulationDemystifying TherapyDepression 101Depression in ContextDialogues on DifferenceDissociative ChildrenDo-It-Yourself Eye Movement Techniques for Emotional HealingDoing CBTE-TherapyEarly WarningEncountering the Sacred in PsychotherapyEnergy Psychology InteractiveErrant SelvesEssays on Philosophical CounselingEssentials of Wais-III AssessmentEthically Challenged ProfessionsEthics and Values in PsychotherapyEthics in Plain EnglishEthics in Psychotherapy and CounselingExistential PsychotherapyExpectationExploring the Self through PhotographyExpressing EmotionFacing Human SufferingFairbairn's Object Relations Theory in the Clinical SettingFamily TherapyFavorite Counseling and Therapy Homework AssignmentsFear of IntimacyFlourishingFolie a DeuxForms of Intersubjectivity in Infant Reasearch and Adult TreatmentFoundations of Ethical Practice, Research, and Teaching in PsychologyFreud and the Question of PseudoscienceFrom Morality to Mental HealthFundamentals of Psychoanalytic TechniqueGenes on the CouchGod & TherapyHalf Empty, Half FullHandbook of Clinical Psychopharmacology for TherapistsHandbook of Counseling and Psychotherapy with Lesbian, Gay, and Bisexual ClientsHandbook of Evidence-Based Therapies for Children and AdolescentsHealing the Heart and Mind with MindfulnessHeinz KohutHelping Children Cope With Disasters and TerrorismHigh RiskHistory of PsychotherapyHow and Why Are Some Therapists Better Than Others?How Clients Make Therapy WorkHow People ChangeHow Psychotherapists DevelopHow to Fail As a TherapistHow to Go to TherapyHypnosis for Inner Conflict ResolutionHypnosis for Smoking CessationI Never Promised You a Rose GardenIf Only I Had KnownIn Others' EyesIn SessionIn Therapy We TrustIn Treatment: Season 1Incorporating Spirituality in Counseling and PsychotherapyInside the SessionInside TherapyIs Long-Term Therapy Unethical?Issues in Philosophical CounselingIt's Not as Bad as It SeemsItís Your HourLearning ACTLearning from Our MistakesLearning Supportive PsychotherapyLetters to a Young TherapistLife CoachingLogotherapy and Existential AnalysisLove's ExecutionerMadness and DemocracyMaking the Big LeapMan's Search for MeaningMetaphoria: Metaphor and Guided Metaphor for Psychotherapy and HealingMind GamesMindfulnessMindfulness and AcceptanceMindfulness-Based Cognitive Therapy for DepressionMindworks: An Introduction to NLPMockingbird YearsMoments of EngagementMomma and the Meaning of LifeMotivational Interviewing: Preparing People For ChangeMulticulturalism and the Therapeutic ProcessMultifamily Groups in the Treatment of Severe Psychiatric DisordersNarrative PracticeOn the CouchOne Nation Under TherapyOur Inner WorldOur Last Great IllusionOutsider ArtOutsider Art and Art TherapyOvercoming Destructive Beliefs, Feelings, and BehaviorsOverexposedPathways to SpiritualityPersonality and PsychotherapyPhilosophical CounselingPhilosophical Counselling and the UnconsciousPhilosophical Issues in Counseling and PsychotherapyPhilosophical PracticePhilosophy and PsychotherapyPhilosophy for Counselling and PsychotherapyPhilosophy PracticePhilosophy's Role in Counseling and PsychotherapyPillar of SaltPlan BPlato, Not Prozac!Polarities of ExperiencesPower GamesPractical Psychoanalysis for Therapists and PatientsPrinciples and Practice of Sex TherapyPsychologists Defying the CrowdPsychology, Psychotherapy, Psychoanalysis, and the Politics of Human RelationshipsPsychosis in the FamilyPsychotherapyPsychotherapyPsychotherapy and ConfidentialityPsychotherapy As PraxisPsychotherapy East and WestPsychotherapy for Children and AdolescentsPsychotherapy for Personality DisordersPsychotherapy Is Worth ItPsychotherapy Isn't What You ThinkPsychotherapy with Adolescent Girls and Young WomenPsychotherapy with Children and AdolescentsPsychotherapy without the SelfPsychotherapy, American Culture, and Social PolicyRapid Cognitive TherapyRational Emotive Behavior TherapyRational Emotive Behavior TherapyRationality and the Pursuit of HappinessRebuilding Shattered LivesReclaiming Our ChildrenRecovery OptionsRelationalityRent Two Films and Let's Talk in the MorningSaving the Modern SoulScience and Pseudoscience in Clinical PsychologySecond-order Change in PsychotherapySelf-Compassion in PsychotherapySelf-Determination Theory in the ClinicSelf-Disclosure in Psychotherapy and RecoverySerious ShoppingSex, Therapy, and KidsSexual Orientation and Psychodynamic PsychotherapySigns of SafetySoul Murder RevisitedStaring at the SunStraight to JesusStrangers to OurselvesSubjective Experience and the Logic of the OtherTaking America Off DrugsTales of PsychotherapyTales of UnknowingTalk is Not EnoughTalking Cures and Placebo EffectsTelling SecretsThe Behavioral Medicine Treatment PlannerThe Body in PsychotherapyThe Brief Couples Therapy Homework Planner with DiskThe Case Formulation Approach to Cognitive-Behavior TherapyThe Challenge for Psychoanalysis and PsychotherapyThe Child and Adolescent Psychotherapy Treatment PlannerThe Clinical Child Documentation SourcebookThe Clinical Documentation SourcebookThe Complete Adult Psychotherapy Treatment PlannerThe Couch and the TreeThe Couples Psychotherapy Treatment PlannerThe Crucible of ExperienceThe Cure of SoulsThe Death of PsychotherapyThe Education of Mrs. BemisThe Ethical Treatment of DepressionThe Ethics of PsychoanalysisThe Gay and Lesbian Psychotherapy Treatment PlannerThe Gift of TherapyThe Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work The Healing JourneyThe Heart & Soul of ChangeThe Heroic ClientThe Husbands and Wives ClubThe Love CureThe Making of a TherapistThe Mindful TherapistThe Mirror Crack'dThe Mummy at the Dining Room TableThe Neuroscience of PsychotherapyThe Neuroscience of Psychotherapy: Healing the Social BrainThe New Rational TherapyThe Older Adult Psychotherapy Treatment PlannerThe Other Side of DesireThe Pastoral Counseling Treatment PlannerThe Philosopher's Autobiography The Pornographer's GriefThe Portable CoachThe Portable Ethicist for Mental Health Professionals The Present Moment in Psychotherapy and Everyday LifeThe Problem of EvilThe Problem with Cognitive Behavioural TherapyThe Psychodynamics of Gender and Gender RoleThe Psychotherapy Documentation PrimerThe Psychotherapy Documentation PrimerThe Psychotherapy of HopeThe Real World Guide to Psychotherapy PracticeThe Schopenhauer CureThe Sex Lives of TeenagersThe Talking CureThe Therapeutic "Aha!"The Therapist's Guide to PsychopharmacologyThe Therapist's Guide to Psychopharmacology, Revised EditionThe Therapist's Ultimate Solution BookThe Trauma of Everyday LifeThe Trouble with IllnessThe UnsayableThe Way of the JournalTheory and Practice of Brief TherapyTherapy with ChildrenTherapy's DelusionsTheraScribe 3.0 for WindowsTheraScribe 4.0Thinking about ThinkingThinking for CliniciansThinking for CliniciansThoughts Without a ThinkerThriveToward a Psychology of AwakeningTracking Mental Health OutcomesTrauma, Truth and ReconciliationTreating Attachment DisordersTreatment for Chronic DepressionTreatment Plans and Interventions for Depression and Anxiety DisordersUnderstanding Child MolestersUnspeakable Truths and Happy EndingsWhat the Buddha FeltWhat Works for Whom?What Works for Whom? Second EditionWhen the Body SpeaksWhispers from the EastWise TherapyWittgenstein and PsychotherapyWorking MindsWoulda, Coulda, ShouldaWriting About PatientsYoga Skills for Therapists:Yoga Therapy
The Great Psychotherapy Debate, as the sub title of the book The Evidence for What Makes Psychotherapy Work indicates, is about how exactly psychotherapy works and what research tells us about different types of treatment, including psychiatric drugs from an historical and anthropological point of view. So, the debate is about what makes psychotherapy works, best characterized by a debate between proponents of evidence-based treatments, namely medical model and proponents of common factors, namely contextual model. The first edition of this book was a seminal publication that helped to organize enormous literature in psychotherapy research regarding the effects of psychotherapy. In the first edition Wampold challenged the long-held belief that psychotherapy can best be understood from a medical model and by using a balanced and carefully selected set of studies, he presented a radical new approach, namely the contextual model, to understanding why psychotherapy works. This second addition updates this work by bringing together the wealth of research examining important issues pertaining to treatment effects since the publication of the first edition and by providing an accessible summary of what we know and what needs to be examined.
The main point Wampold emphasizes is that the practice of psychotherapy and counseling is dedicated to helping individuals lead happier, more productive, and satisfying lives by helping to relieve the distress that motivated them to seek help. A purposeful collaborative relationship between a therapist and the patient, which Wampold calls a therapeutic alliance, is one of the common elements of effective therapies. He believes that psychotherapy as an effective healing practice needs to be promoted by professional organizations and therapists, instead of just prescribing the pill and expect the patient go on with his/her life. The contextual model, which in the first edition of The Great Psychotherapy Debate he presents as a compelling alternative to traditional research on psychotherapy, which tends to focus on identifying the most effective treatment for particular disorders through emphasizing the specific ingredients of the treatment, is instead derived from a scientific understanding of how humans heal in a social context and focuses on common factors such as alliance, empathy and expectations.
In this book, a critical examination of the progress in psychotherapy is undertaken with attention to the hidden, forgotten and ignored factors, as well as to the current practices, policies and research. The first chapter of the book titled History of Medicine, Methods, and Psychotherapy is intended to give a brief history of medicine and psychotherapy so that certain consequences from history are fully understood and that the current debate is put into a proper perspective before the evidence for the contextual model is presented in the following chapters.
The Contextual Model with the expansions based on social science research since it was first proposed in the first edition of The Great Psychotherapy Debate is presented in the second chapter. In this chapter, Wampold reviews alternatives to understanding psychotherapy from a specific theoretical orientation but focus primarily on such a model, the Contextual Model, which takes psychotherapy as a socially situated healing practice. The chapter ends with the proposal of the Contextual Model that the real relationship, expectations and specific ingredients are the three pathways that create change in psychotherapy.
The following chapter is the presentation of the evidence to be considered and the discussion of the conjectures of the Medical Model and the Contextual Model by adopting a reconstruction of science perspective of Lakatos. After concluding that the conjectures of the Medical Model and the Contextual Model predict very different outcomes of various psychotherapy investigations in Chapter 3, Chapters 4 and 5 examines the evidence for absolute efficacy and relative efficacy, respectively.
Chapter 4 presents the benefits of psychotherapy established by meta-analysis and concludes that the history of the investigations of psychotherapy efficacy establishes meta-analysis as an objective and useful way to aggregate studies addressing the same hypothesis. In the next chapter the evidence related to the relative efficacy of various psychotherapies is explored. Drawing upon the Dodo Bird effect referring to uniform efficacy of psychotherapies, proposed by Rosenberg, the chapter concludes that since the Dodo Bird conjecture has survived many tests, uniform efficacy of treatments represents the first evidence that the medical Model cannot explain the empirical findings in psychotherapy research.
The following chapter investigates an ignored but critical factor in the efficacy of psychotherapy, namely therapist effects. As the reviewed evidence supports some therapists achieve better outcomes than others despite the treatment provided, an important question arises: “what are the characteristics and actions of an effective therapist?” This question is the topic of the following two chapters. Chapter 7 considers the general effects by meeting challenges and anticipating additional evidence for the Contextual Model. In this chapter, authors focus directly on the working alliance first of all because the alliance is a central construct in the Contextual Model and also for some other reasons, such that the alliance has long been theorized to be a pan-theoretical construct that is critical to the success of all treatments, that there is more research on the alliance than on any other factor and that the alliance as a therapeutic factor has come under much scrutiny from adherents of the Medical Model, on a number of quite legitimate grounds.
After examining the evidence for general effects, in the Chapter 8, they examine the evidence for specific ingredients. They ask whether the purported ingredients of an effective treatment responsible for the benefits of the treatment, and after reviewing the research, conclude that there is no compelling evidence that the specific ingredients of any psychotherapy or specific ingredients in general are critical to producing the benefits of psychotherapy.
The last chapter titled as Beyond The Debate is about the implications of the research synthesis for theory, policy and practice. They come to the conclusion that the Contextual Model is based on scientific grounds and in the light of the future research, both models have the opportunity to show their scientific worth as well as the worth of the implications for the policy, practice and training.
This new edition of The Great Psychotherapy Debate, with its inclusion of history of healing practices, medicine and psychotherapy and a thoughtful review and summary of the research in the area on common factors such as the alliance, expectations and empathy, updates the work that started in the first edition greatly, and extends the discussion on the effects of psychotherapy along different pathways, offering important implications for the future of the field. Because the scope of the book is broad enough to cover both theoretical and historical issues and also thorough, sophisticated empirical analyses, it is of use for both a psychotherapist in the field or a skilled psychotherapy researcher as well as an advanced psychology or counseling student. I heartily recommend this book for any graduate course on psychotherapy and also for anyone who wants to conduct psychotherapy research.
© 2015 Kamuran Elbeyoğlu
Prof. Dr. Kamuran Elbeyoğlu, Toros University, Psychology Department, Mersin, Turkey