The Great Psychotherapy Debate: Models, Methods, and Findings

By Bruce E. Wampold | Go to book overview

2
Differential Hypotheses and Evidentiary Rules

The medical model and the contextual model provide two very different conceptualizations of psychotherapy. The medical model of psychotherapy patterns itself after the medical model in medicine, has the trappings of a scientific endeavor, and is the darling of those who see themselves as rigorous, serious clinical researchers. To question the validity of the medical model is to entertain the thought that psychotherapy is a “touchy-feely” movement supported by well-intentioned but soft-headed practitioners who want to ignore scientific evidence and be guided by their clinical judgement and intuition. But what if the scientific evidence casts doubt on the very edifice that has “science” written on its front door?

For years, there has been a nagging suspicion that the medical model may not be able to account for many research results that have appeared in the literature. For example, the ubiquitous and robust finding that all psychotherapies intended to be therapeutic are equally efficacious (see chap. 4) is incompatible with the specificity component of the medical model because it suggests that all specific ingredients are equally potent and all theoretical orientations equally valid. Nevertheless, adherents to the medical model, in various ways, dismiss these results. Some would say that the results are ipso facto incorrect:

If the indiscriminate distribution of prizes carried true conviction… we end up with the same advice of everyone—”Regardless of the nature of your problem seek any form of psychotherapy.” This is absurd. We doubt even the strongest advocates of the Dodo Bird argument dispense this advice. (Rachman & Wilson, 1980, p. 167)

-31-

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