Academic journal article Canadian Journal of Psychiatry

Psychotherapy Research at the Start of the 21st Century: The Persistence of the Art versus Science Controversy

Academic journal article Canadian Journal of Psychiatry

Psychotherapy Research at the Start of the 21st Century: The Persistence of the Art versus Science Controversy

Article excerpt

This article offers an overview of prominent general trends in the field of psychotherapy research. We consider 3 areas of the literature: metaanalytic reviews addressing the effectiveness of psychotherapy, the movement to identify empirically supported treatments (EST), and research on the "common factor" or "contextual" models of psychotherapy. We present narrative reviews of selected literature associated with each area. The reviews highlight several issues currently confronting the field. Metaanalytic reviews underscore 2 conclusions: psychotherapy is superior to the absence of treatment, and different approaches to psychotherapy yield equivalent effects. In counterpoint to these findings, the EST movement emphasizes the empirical demonstration that specific psychotherapies have efficacy for specific disorders. Misinterpretation of EST findings has led to considerable controversy. Although EST research can identify causal effects of therapy, it has less capacity to explain how these effects come about. We suggest an appropriate perspective on EST findings. Considerable evidence supports the importance of common factors as mechanisms of change; at present, however, this evidence is predominantly correlational. We conclude that a blending of EST studies and research on the common factors represents the greatest potential for advancing the field. Studies to identify specific ESTs are key to validating the efficacy of psychotherapy approaches and need to be undertaken with the psychodynamic and experiential therapies. Greater emphasis on common factors in research, training, and practice can advance understanding about change processes in efficacious therapies, facilitate the development of sensitive clinicians, and increase the effectiveness of mental health services.

(Can J Psychiatry 2006;51:797-809)

Information on funding and support and author affiliations appears at the end of the article.

Highlights

* Metaanalytic reviews have provided compelling support for the effectiveness of psychotherapy approaches to the treatment of mental disorders, defined broadly.

* By contrast, the designation of particular psychotherapies as "empirically supported treatments" is based on efforts to identify specific interventions that have efficacy for the treatment of specific disorders as defined by the DSM.

* Research on elements regarded as being common to effective therapies has provided some suggestion as to what may be curative about psychotherapy. For the most part, however, the studies are based on a correlational paradigm, and the evidence for the causal effects of the common factors is consequently minimal.

* Psychotherapy research is most likely to advance if these somewhat disparate investigational paradigms can be integrated. A blending of efficacy studies and process-outcome investigations is also likely to yield information particularly useful in the training of clinicians.

Key Words: psychotherapy research, therapy outcome, metaanalysis, empirically supported treatment, common factors, mechanisms of change

Abbreviations used in this article

APA American Psychological Association

CBT cognitive-behavioural therapy

CT cognitive therapy

EST empirically supported treatment

NHS National Health Service

RCT randomized clinical trial

STPP short-term psychodynamic psychotherapy

Résumé : La recherche sur la psychothérapie au début du 21e siècle : la persistance de la controverse entre art et science

Cet article offre un survol des grandes tendances générales du domaine de la recherche sur la psychothérapie. Nous examinons 3 secteurs de la documentation : les études méta-analytiques portant sur l'efficacité de la psychothérapie, le mouvement qui identifie les traitements soutenus empiriquement (TSE), et la recherche sur le « facteur commun » ou les modèles « contextuels » de la psychothérapie. …

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