Last updated on 29th August 2011
I wrote a few days ago about Barry Duncan's recent book "On becoming a better therapist". Duncan cites three major influences shaping the book. One, he said, has been his involvement as an editor in the recently published, multi-authored "The heart and soul of change: delivering what works in therapy". This latter book, Barry writes "gathered the field's most prominent thinkers to address what works in therapy, and more important, how to deliver it to our clients. As the first editor, I was privileged to be intimately involved in every chapter and was therefore privy to the thinking of these noted psychotherapy research scholars' latest reviews of and reflections about the data ... (On becoming a better therapist), in essence, is the clinical companion of 'The heart and soul of change'; it not only implements its findings regarding the common factors that fuel therapeutic transformation but also details the pragmatics of that volume's primary recommendations: Clinicians should routinely collect client-based feedback and tailor services accordingly."
Gathering " ... the field's most prominent thinkers to address what works in therapy, and more important, how to deliver it to our clients" seems a pretty interesting endeavour. I've had a look at the "The heart and soul of change". This second edition was published just last year, so it's pretty up-to-date in its review of the psychotherapy literature. There are over two dozen expert contributors and the fourteen chapters (and 455 pages) cover four main sections - I. What works and what does not: the empirical foundations for the common factors. II. Delivering what works: practice-based evidence. III. Special populations. IV. Conclusions. There is also a foreword by David Orlinsky and an introducton by the four editors - Hubble, Duncan, Miller & Wampold.
In his foreword Orlinksky argues for an alternative research-based psychotherapy paradigm to replace what he describes as the established but overly narrow, ill-fitting one that is based on an analogy between psychotherapy and pharmacotherapy. He states that "The alternative paradigm, articulately presented and expertly documented in this volume, holds that therapeutic efficacy inheres primarily in the patient's experience and in the use of a remoralizing, resource-enhancing, and motivating relationship with a therapist who is supportive and challenging (in proportions and at times that suit the patient's needs and abilities). The therapist's procedures are important but become effective largely by contributing to the formation and development of this relationship in the patient's experience. This view provides a better fit with the cumulative findings of psychotherapy research than does the pharmacological paradigm, as various chapters in this book show." Mm ... I don't know whether Orlinsky would argue that cognitive-behavioural approaches tend to use an "outdated pharmacological paradigm." I suspect he would. Usually one finds that there is truth and usefulness on "both sides" in these arguments. There are posts from last month's BABCP conference that tend to support Orlinsky's viewpoint - see "What shall we do about the fact that there are supershrinks and pseudoshrinks?" and "The Dodo assertion - all good depression treatments are equally effective". There are also recent posts on this site that challenge what he claims - see "Rolls Royce therapy and Anke Ehlers on PTSD" and "CBT is better than interpersonal psychotherapy for social anxiety disorder". And to do Orlinsky justice, he too would agree that different therapy approaches are likely to be more or less helpful for different clients. However he holds, interestingly and challengingly, that "The heart and soul of change" provides an integrative conceptual framework that will enable therapists to "know more and do more, without negating the essentials of what they currently know and do".
And central to this "doing more" is the practice of session-by-session monitoring and feedback. As the editors propose in their introduction "In the end, monitoring outcomes may provide a common ground for those who advocate empirically supported treatments and those who espouse the importance of common factors." I heartily agree. They point out that "The combination of measuring progress (i.e. monitoring) and providing feedback consistently yields clinically significant change ... Rates of deterioration are cut in half, as is dropout. Include feedback about the client's formal assessment of the relationship, and the client is less likely to deteriorate, more likely to stay longer, and twice as likely to achieve a clinically significant change." Sounds like territory of interest to any thoughtful psychotherapist. Bring it on!