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Research: A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “all must have prizes”<\/a><\/strong>
This is a seminal meta-analysis. This high-impact study had twice that of the next highest-cited relevant article in the Web of Science (WoS) citations.
Before this 1997 article, previous studies had not conducted true comparisons. Take, for instance, 8 out of 13 so-called \u201cdynamic-humanistic\u201d studies used for treatment comparisons did not actually contained therapeutic elements and \u201ccould be viewed as a straw man\u201d (Shapiro & Shapiro, 1982, p. 591).\nAlso, comparing with a wait-list or no-treatment, isn\u2019t exactly good enough. Something is often better than nothing.<\/p>\n
Wampold et al. define what a \u201cbona fide\u201d psychotherapy comparison:<\/p>\n
\u201c\u2026those that were delivered by trained therapists<\/strong> and were based on psychological principles<\/strong>, were offered to the psychotherapy community as viable<\/strong> treatments<\/strong> (e.g., through professional books or manuals), or contained specified components.\u201d<\/p>\n
Key Graf:<\/strong>
– \u201cThe results of our analysis demonstrated that the distribution of effect sizes produced by comparing two bona fide psychotherapeutic treatments was consistent with the hypothesis that the true difference is zero<\/strong>.\u201dThe effect size for the comparison of bona fide psychotherapies is in the interval of .00 and .21.<\/strong><\/p>\n![\"\"](\"http:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2023\/05\/0942db76-92db-4358-8736-7fa3325c53ca_442x220.jpg\")
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Commentary: Brave new world: Mental health services 25 years since Dodo and 25 years in the future<\/a>
<\/strong>Here\u2019s Wampold commenting on their article in 1997.\nKey Graf:<\/strong>
– \u201cI am skeptical of improving services by implementing purportedly superior treatments in a system of care, based on a randomized clinical trial, because
(a) the results often defy reasonable explanations,
(b) implementing results from clinical trials in other contexts is fraught with difficulty,
(c) psychotherapy trials rarely if ever are replicated,
(d) differences among therapists, due to their clinical skills, are more important than differences among treatments,<\/strong> even if a treatment is demonstrably (but marginally) better, and
(e) such implementation reduces therapist and patient preferences and leads to therapist discouragement.
– The designation of the RCT as the gold standard of psychotherapy research has set us back decades<\/strong>\u2014to wit, identify one clinically actionable conclusion from RCTs, which by the way have cost hundreds of million of dollars.\u201d
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- Commentary<\/strong>: Smaller effects matter in the psychological therapies: 25 years on from Wampold et al. (1997)<\/a><\/strong>
Michael Barkham highlighted an interesting point about the value of systematically monitoring outcomes:\n– \u201cConsider a recent large meta-analysis reporting an overall ES d of 0.15 for routine outcome monitoring, increasing marginally to 0.17 for patients not-on-track (de Jong et al., 2021).
– While classed as a small effect, it is additive<\/strong><\/em> to the existing overall effect of psychotherapy<\/strong> (i.e., it is an effect over and above the general effect of psychological therapies).\u201d<\/p>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n\n\n\n<\/p>\n
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- Commentary<\/strong>: The implications of the Dodo bird verdict for training in psychotherapy<\/a>
<\/strong>Given my struggles in the formal education process, training and learning is one area I deeply care about.
Henny Westra raises some unsettling findings about the current state of training in the field of psychotherapy:\n– \u201cthere is no evidence<\/strong> that continuing education workshops<\/strong>\u2026 produce sustained skill development\u2014quite the opposite.
– Large effects on self-report are found but any modest improvement in performance erodes over time without further coaching.\u201d<\/p>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n\n\n\n<\/p>\n
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Words Worth Contemplating:<\/strong>
\u201cIt\u2019s not enough to rage against the lie. You\u2019ve got to replace it with the truth.\u201d<\/strong>
~ Bono, U2.<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n\n\n<\/p>\n
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Reflection:<\/strong><\/h3>\n
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Take another look at the Table above taken from The Great Psychotherapy Debate. What strikes you?
Where have you been investing your time, money and effort in your professional development?<\/em><\/p>
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PART II<\/h2>\n
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- Watch: The Psychotherapy Debate with Peter Fonagy and Bruce Wampold<\/a>
<\/strong>This is a must-watch.
<\/strong>Peter Fonagy, known for his contributions in mentalisation-based treatment, and Bruce Wampold, the leading researching in the contextual model, debates on perennial questions in psychotherapy i.e., \u201cAre some psychological treatments more effective than others?\u201d \u201cHow do we become better therapists?\u201d \u201cWhat is the future of psychotherapy research?\u201d\n![\"\"](\"http:\/\/darylchow.com\/frontiers\/wp-content\/uploads\/2023\/05\/Screenshot-2023-11-20-110936.jpg\")
<\/a><\/p>\nKey Grafs:
On Ethics:<\/strong>
– 4:13min: [Peter Fonagy] It is our responsibility to our patients what works and for whom<\/strong> the answer to that is an absolute<\/em> and unequivocal yes. I would consider any attempt to hinder that process to be both unethical and unacceptable intellectually.<\/p>\n– 8:26min: [Bruce Wampold] \u2026 How is it we keep developing new therapies and the outcomes we get with patients really have not improved over time? This is disturbing to me.<\/p>\n
On What Makes a Difference in Outcome<\/strong>
– [BW cont.] \u2026what really makes a difference<\/strong> is the therapists.<\/strong> There are some really good cognitive behavioral therapists who do a great job and when I say a great job I’m not talking abou tthey look good if you observe them. I mean, they actually achieve good outcomes with their patients.<\/p>\nBut there’s some very poor cognitive behavior therapists and with dynamic therapist, emotion-focused therapists\u2026 The key to success and you got to the epistemic trust is that some therapists have the skills to be able to help patients regardless of the treatment.<\/p>\n
– 9:47min: [BW] The continued focus on treatment really puts the spotlight in the wrong place. regardless of the treatment. the continued focus on treatment really puts the spotlight in the wrong place. okay. It\u2019s us\u2014therapists who make therapy work.<\/p>\n
On What Doesn\u2019t Work<\/strong>
– 10:45mins: [BW] What doesn\u2019t work is just sitting with the patient and beingempathic understanding okay. Treatments without structure<\/strong> without some way for the patient to workhard to overcome their difficulties don’t work as well as focus treatments and CBT has really taught this.<\/p>\n– In the eating disorder area the trial that Stig Polson and colleagues did where they compared CBT to psychoanalytic therapy didn’t do as well because the patients were allowed to come in and talk about anything they wanted.<\/strong> It was their choice whether they talked about an eating disorder\u2026 and the difficulty is difficult so they avoided it<\/strong> and so did the therapist so they never worked on what the focal problem.
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– 12:32mins: [PF] I think that what happens in therapy across the 1246 different kinds of psychotherapy is that there are is that if you have a decent and scientifically or empirically based a model<\/strong> of the client and you are actually able to say something to the client that they find helpful.<\/p>\n– 16:30mins: [BW] I would contend that <\/strong>every understanding of a disorder is wrong.We will find out in 10 or 15 or 20 years every explanation you have will be supplanted by a new one<\/strong>..1<\/a>. Not necessarily going to be a true one.What’s really important… Is that the patient accepts the explanation, ok, whether it’s evidenced-based or not.<\/strong><\/p>\n
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On Clinical Supervision
<\/strong>– 27mins: [PF]: I’m making something it is deadly serious here, that is, unless and until we put supervision that’s based on actual<\/em> clinical material rather than one’s fantasy about what occurred \u2026unless you actually do it on what had happened it’s probably not very useful.2<\/a><\/p>\nWell worth your time to listen to this two leading figures in our field.<\/p>\n<\/li>\n<\/ol>\n<\/li>\n<\/ol>\n
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- Words Worth Contemplating:<\/strong>
I’ve looked at love from both sides now
From give and take and still somehow
It’s love’s illusions that I recall
I really don’t know love
Really don’t know love at all.<\/em>\n
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- Watch: The Psychotherapy Debate with Peter Fonagy and Bruce Wampold<\/a>
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