Psychotherapy Research:“Horse Race”Versus Process

Abstract

In the new world of hard-nosed, evidence-based medicine, evidence is emerging that specific psychotherapy techniques have efficacy for specific psychiatric disorders. However, evidence from studies comparing the efficacy of various specific psychotherapies indicates that they are equally effective overall. In addition, clinical experience demonstrates overwhelmingly that, in the real world, our present diagnostic categories overlap greatly, and individual drugs may be efficacious for multiple disorders, so that disorder-based specificity is something of a mirage. For example, depression, anxiety, maladaptive personality traits, and a substance use disorder commonly co-exist in the same patient, requiring that the selection of psychotherapeutic modalities as well as medications be tailored to the unique needs of the individual. In this guest column, Bernard Beitman brings a fresh perspective to thinking about evidence-based psychotherapy—a perspective consistent with the clinical experience of psychotherapists. He focuses on the essential processes characteristic of all of the widely practiced psychotherapies, their neurobiological substrates, and their relation to efficacy.