Towards a more Scientific Approach to Psychotherapy

On Psychotherapy

Most therapists believe that the treatment approach/model that they utilize is clearly the best way to do therapy.  I can remember as far back as graduate school, where the Behaviorist would argue with the Psychoanalyst about whose model was right.  Debates about the best model or approach have proliferated since that time and advocates of different models have continued to assert why their model is the best.  To complicate matters there has been a proliferation of treatment models, with the proponents of each new model touting their models benefits and superiority. 

In sharp contrast to the proliferation of models and the assertion of model superiority, what Scott Miller has referred to as the idea that a given model “has the secret sauce,” the special ingredient that makes it superior, there has been an increased focus on both evidence based treatment and the common factors model.  Evidence based approaches stress that a given model has shown to be effective. Unfortunately, this approach has not distinguished between models so much as it has morphed into an every lengthier list of effective approaches. In contrast, the common factors approach has argued that the “common factors”, the key components of therapy that are common to all major models of psychotherapy, are what account for psychotherapy’s effectiveness.  

My reading of the literature strongly suggests that the preponderance of evidence supports the common factors approach. Research by psychologists such as Norcorss and Lambert have highlighted the central importance of the therapeutic alliance in accounting for therapy’s effectiveness. Research by Lambert has also highlighted the importance of expectation, the client’s belief that therapy will be helpful, of value.  Other groups of researchers, such as Scott Miller and his colleagues have stressed the importance of the therapeutic alliance, along with empathy, an agreement on methods and goals, and client feedback (focusing both on progress made and the therapeutic alliance) as key factors. All of these researchers have also reminded us that what they refer to as “extra-therapeutic factors”, things happening outside of therapy, are the major drivers of change.  A humbling fact we should all keep in mind. 

My goal in highlighting these issues is not to impugn the advocates of different approaches to treatment. All therapists need a model that guides their work and which provides their clients with a framework for understanding their struggles. Moreover, there may be some evidence that specific models are particularly efficacious with specific problems, e.g., Cognitive Behavioral Therapy with the treatment of Panic Disorder. Rather, my goal is to encourage us all to think more rationally and scientifically about therapy, and focus more on the factors that research has shown to be critical to therapeutic progress. For example, work by Scott Miller and his colleagues, Michael Lambert, and Jeb Brown, to name a few, has shown that consistently obtaining client feedback in a systematic manner improves therapeutic outcomes.  As our goal is to do our best job in assisting our patients we should all be focused on what science tells us matters. 



For a concise discussion of the history of the common factors model the Wikepdia entry on the topic is recommended.

Scott Miller’s blogs offer brief summaries and references to more in depth writings onf the value of Feedback Informed therapy.

John Norcross and Michael Lambert both have written extensively on issues related to psychotherapy outcome and effectiveness.  Other authors who have also written and researched this topic include Scott Miller, Bruce Wampold, and a plethora of others too numerous to mention. 

Recommended readings include:

Prevention of  Treatment Failure, by Michael J. Lambert.  However, for a shorter introduction to his work please see his interview on this topic:

The following article by Norcross and Wampold provides a concise review of the topic and examines the factors that contribute to therapeutic effectiveness. 

Norcross, J. C., & Wampold, B. E. (2011). Evidence-based therapy relationships: Research conclusions and clinical practices. Psychotherapy, 48(1), 98–102.

A thorough discussion of how common factors are critical in marriage and family therapy is found in, Common Factors in Couple and Family Therapy: The Overlooked Foundation for Effective Practice, Douglas H. Sprenkle, Sean D. Davis, Jay L. Lebow 

A free pdf of the book is available at: