Magazine article Family Therapy Networker

No More Bells and Whistles: No More Bells and Whistles

Magazine article Family Therapy Networker

No More Bells and Whistles: No More Bells and Whistles

Article excerpt

IN ONE ANCIENT ZEN STORY, THE MASTER OF FOUR apprentice monks who are seeking enlightenment counsels them to observe strict silence. Upon hearing this, the first young monk responds impetuously, "Then I shall not say a word." The second monk then chastises the first, saying, "Ha, you have already spoken." "Both of you are stupid," the third monk remarks and then asks, "Why did you talk?" In a proud voice, the fourth monk concludes, "I am the only one who has not said anything!"

These four apprentice monks competing to show their unique grasp of the truth are not unlike the proponents of various treatment models in the field of therapy. All are eager to demonstrate their special insight into the mysteries of the treatment process and the superiority of their chosen method. Yet while the number of therapy models has proliferated, mushrooming from 60 to more than 400 since the mid-1960s, 30 years of clinical outcome research have not found any one theory, model, method or package of techniques to be reliably better than any other. In fact, virtually all of the available data indicate that the different therapy models, from psycho-dynamic and client-centered approaches to marriage and family therapies, work equally well. (1) This startling truth applies even to comparisons between talk therapies and the much-ballyhooed advances in biological psychiatry. Recent publicity aside, data comparing a variety of psychotropic medications with numerous psychological interventions indicate that they all achieve roughly equivalent results. Furthermore, findings that once appeared to show the superiority of cognitive and behavioral therapies turned out to be artifacts of the measures being used and the confirmatory bias of the investigators.

Given the clear demonstrations from research that there is little appreciable difference in outcome among the various therapy models, it is puzzling that they remain the centerpiece of so many graduate education programs, continuing education seminars and professional publications. How can something that makes so little difference continue to dominate professional discussion? The answer is simple: treatment models really do make a difference, just not to the client.

Consider the current popularity of brief therapy. Proponents of these approaches have gone to great lengths to point out the difference between brief and more traditional forms of treatment. The differences are so numerous that Steve deShazer, the developer of one brief treatment approach, devoted no less than five chapters to detailing them in his book, P utting Difference to Work. The proponents of brief therapy promise that these differences translate into more efficient and more effective forms of clinical practice. For example, in Shifting Contexts: The Generation of Effective Therapy, Bill O'Hanlon and James Wilk claim their brief therapy approach will enable clinicians to "achieve dramatic therapeutic successes more rapidly, more enduringly, more effortlessly, more pleasurably, and more reliably than any psychotherapeutic approach [and] most in a single session."

The only problem is that there is not a single shred of evidence to support such claims. In fact, there is not any evidence that brief therapy is actually briefer than existing therapeutic approaches. (2) Rather, the research clearly indicates that most therapy is of relatively short duration and always has been regardless of the treatment model employed. The average client of any therapy, for example only attends five or six sessions! Similarly, there is no evidence that brief therapy results in more single-session cures. Once again, the research indicates that a single session is the modal number of sessions for all clients in therapy regardless of the treatment model employed. Finally, there is absolutely no evidence that brief therapy results in more effortless, reliable or even enduring change than "longer term" treatment. Indeed, available data suggest that brief therapy achieves roughly the same results as the traditional approaches they are supposed to replace. …

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