The dodo-bird debate, empirically supported relationships and functional analytic psychotherapy.

Abstract

Abstract The dodo-bird verdict has haunted the literature on psychotherapy outcome since its early beginnings. It is based on the counter-intuitive finding that often highly diverging treatments do not differ much in effectiveness. There is evidence that much of the common effect of different treatments can be related to unspecific factors as opposed to treatment-specific techniques. The present paper offers a short behavior analytic reflection on contemporary directions concerning effective therapeutic relationships. It suggests that the idiographic vision inherent in functional analysis may point at an alternative avenue for psychotherapy outcome research that is entirely different from those on empirically supported treatments and empirically supported relationships, and that this third direction may shed more light on the question as to what determines therapeutic change. Key-words: Dodo-bird verdict; Empirically supported therapies; Therapeutic relationship; Functional Analytic Psychotherapy. ********** Since the advent of research on the effectiveness of specific treatments for specific disorders (Eysenck, 1952; Chambless, 1996) therapy advanced tremendously and it seems it will never be the same again. As a result of this work, the well-trained therapist of today, confronting a client with this or that particular disorder will be able to choose and implement the treatment-package that will most probably be helpful. The bottom line is that a treatment that has been shown most helpful in studies for clients with a specific problem and specific characteristics, will be the most indicated treatment for a client one will meet in one's office with that same problem and those same characteristics. Critics of this development have been prolific. It has been pointed out that technique-driven protocols cannot consider the complexity of the therapeutic process and that the ecologic validity of the controlled studies is weak because the therapy settings in clinical practice vary widely (Garfield, 1996; Goldfried & Wolfe, 1996; 1998; Bohart, 2000). The Dodo-Bird Verdict Metanalyses (e.g. Smith, Glass & Miller, 1980; Wampold, et al., 1997; Luborsky et al., 2002) tend to corroborate Rozenzweig's (1936) verdict that everybody has won and must have prizes, a line taken from the Dodo-bird in Lewis Caroll's Alice's Adventures in Wonderland. That very dissimilar interventions have similar effects diminished the seeming importance of specific techniques. The Dodo-bird verdict came to evoke in specialists at least three standard types of reaction. A first type consists in pointing out that the meta-analyses don't permit disqualifying the effects of techniques and that it is more ethical to use techniques that have empirical support than to speculate about unspecific variables. Continued controlled studies are necessary to show what variables or interactions contribute to therapeutic changes (Eysenck, 1994; Chambless, 2002). A second type of reaction points at unspecific variables as holding the major promise for explaining what makes therapy work (Bohart, 2000; Messer & Wampold, 2002). The therapeutic encounter in itself can have an important effect on the client and the therapist as a person makes a difference. Characteristics of the relationship compete with specific techniques as possible explanations of why therapies work. They are often common to many different treatments, and have enough empirical support to give them a place alongside specific techniques in models about the active ingredients of therapy. Efforts to identify core relationship variables have been examined by a task force of the American Psychological Association's division 29 and reviewed in a book organized by Norcross (2002). These empirically supported relationships are aspects of the way in which client and therapist interact, that research has been able to relate favorably to treatment outcome or process. …