So therapies are therapeutically effective; this result of the studies spurs us on to integrate their therapeutic power into the work of Christian ministry. But two other cumulative results of the scientific literature on psychotherapy outcomes raise serious questions about such a project of integration. The first is the “Dodo bird verdict”: Like the Dodo bird in Alice and Wonderland, who declares that “Everyone has won and all must have prizes,” the studies generally show that practitioners of the various competing schools of therapy are all about equally therapeutically effective.
This is a surprising result, given the diversity among the therapies and the way psychotherapies purport to work. Therapies purport to intervene in a client’s mind and behavior in a way prescribed by a pattern of explanation of dysfunction. For example, cognitive therapy explains emotional dysfunction by reference to irrational cognitions and thus treats clients by attempting to correct the erring cognitions. Psychodynamic therapies explain dysfunction by reference to repressed memories of traumatic childhood experiences with significant others, and so treat clients by trying to explore the past and create transferences to the therapist that will enable a working through of the memories. Rogerian therapy attributes dysfunction to introjected socially imposed conditions of worth (“I have worth only if I’m as big a financial success as my Dad”), and so treats the problem by having the therapist supply unconditional positive regard for the client which frees the client to follow his authentic internal valuing process. Some family therapies explain dysfunction by reference to improper constellations of family relationships, and so attack the problems by attempting to rearrange these relationships.
With such diversity of explanatory frameworks and their correlated interventions, one would expect some therapies to work much better than others. It is hard to see how all could have a precisely correct diagnosis of dysfunction, and yet they purport to work because they correctly explain the source of psychological problems. If we took our malfunctioning car to several mechanics, and they all explained the malfunction in diverse ways—one says the problem is the spark plug wires, another says it’s the fuel injectors, another that it’s the kind of fuel we are using—we would expect that only one of them (at most), applying her prescribed remedy, would be very successful in solving the problem. We would be astounded to find that regardless of what remedy was applied, the car was equally well fixed! It is for this reason that Lambert and Bergin suggest that the factors by which the various schools of therapy explain their therapeutic success may not be what is causing the success.
This hypothesis is strengthened by a second unexpected finding of the research on psychotherapy outcomes, namely that people with a great deal of training and experience in therapy—say, a Ph.D. in clinical psychology and several years of practice—are no more successful in alleviating people’s problems than counselors with minimal training or even no training at all. This is what we would expect if the training and experience were training and experience in the distinctive theory and practice of some psychotherapeutic model (or an eclectic agglomeration of such distinctives from several models). That is, if what is distinctive about therapies is not what is doing the therapeutic work, then deeper training and greater experience in such distinctives is not going to improve outcomes.
But even if the theory and allied practices of therapeutic models are not what makes them therapeutically effective, the fact remains that they are effective. What can it be about them that makes them so? No one knows for sure, but the best guess, according to Lambert and Bergin, is that it is factors that all or many of the therapies have in common. What factors are these? In most if not all therapies, the therapist comes across as an expert, and the client is inspired to trust him or her. This gives the client a sense that his or her problem is being addressed in an effective manner, and motivates the client to make an effort to get better. In most therapies, the client is encouraged to articulate his or her problem, and thus come to a more immediate experiential confrontation with it. In many therapies, the therapist gives the client some advice, or at least points the client toward some behaviors that are contrary to the dysfunctional patterns that led him or her to therapy. In many therapies, the therapist conveys to the client a sense of having been empathically understood. And finally, any time a client is engaged in therapy, he or she is actively engaged in solving the problem.
Robert Roberts, “Psychotherapy and Christian Ministry”, in The Southern Baptist Journal of Theology, vol. 7, no. 4, p. 44-45
The work cited by Michael Lambert and Allen Bergin is in “The Effectiveness of Psychotherapy” in Handbook of Psychotherapy and Behavior Change, 143-189.