Re Messer's conclusion that all "bona fide" therapies are equally effective

Messer has a good point. If a particular therapy for a given problem is "empirically supported," that does not necessarily mean that the therapy is more effective than other treatments for that problem. It does not even mean that it is as effective as other empirically-supported treatments (ESTs) for that problem. It only means that we have enough empirical evidence to conclude that it is an effective treatment for the problem in question.

Some proponents of ESTs get carried away and talk as though we know that ESTs are more effective than therapies are more effective than therapies that have not been empirically tested but that is not the case. It is quite possible that some of the other treatment approaches are wonderfully effective. However, until they are tested, we won't know if they are effective or not.

Unfortunately, there are some problems with Messer's other conclusions. He talks as though there is empirical evidence that psychodynamic therapy, client-centered therapy, and marital therapy are just as effective as CBT across the board. That is simply not true.

It is true that when you do overall comparisons of the effectiveness of generap schools of therapy with a broad range of problems that no one approach to therapy appears to be superior across the board. However, when you look at the evidence regarding the effectiveness of specific treatment approaches for specific problems, there are some treatment approaches where there is sufficient evidence to confidently conclude that the treatment is effective and there are other treatment approaches where we do not have sufficient evidence to be confident that the treatment is effective. For example, we have clear evidence that CBT is effective as a treatment for OCD and, the last time I looked, there was no evidence that psychodynamic therapy, client-centered therapy, or marital therapy were effective treatments for OCD.

He is correct in concluding that "common factors" or "non-specific factors" such as placebo effects, working alliance, therapist allegiance, and therapist competence, etc. are important. They may even turn out to be more important than specific intervention techniques with some problems. However, the relative importance of non-specific factors vs. specific intervention techniques has not yet been tested with most problems.

It would be interesting to know if "old fashion attributes like faith, love, and hope end up being the key factors in predicting and determining whether one will be an effective therapist." However, that research has not yet been done. Faith, hope, and love are all good things but I will be surprised if that turns out that they are the key determinants of treatment effectiveness.

Think about it for a minute... If faith, hope, and love are all that is needed, why bother learning how to do therapy? All people with problems would need to do is to talk with their pastor, priest, rabbi, mullah, or shaman. With many problems there is clear evidence that ESTs offer more than a caring listener without training can provide.

Replies:

Specificity of treatment, by Carl Robbins, 01/14/03 Is it true that "All have won and deserve prizes"? , by Jim Pretzer, 04/26/04

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