The dodo bird revisited: A qualitative study of psychotherapy efficacy research

Abstract

This article is a qualitative study of psychotherapy efficacy research spanning more than four decades. The findings are organized into five temporal categories characterizing the evolution of psychotherapy research. All five categories are integrated in the central phenomenon of two views of human behavior, a reactive or a proactive view. The categories are (1) psychotherapy is no more effective than no psychotherapy (1950s and 1960s), (2) the “core conditions” (empathic understanding, unconditional positive regard, and congruency) are necessary and sufficient conditions for therapeutic personality change (1960s and 1970s), (3) psychotherapy is for better or for worse (early 1960s), (4) the core conditions are necessary but not sufficient for therapeutic personality change (late 1970s and mid-1980s), and (5) specific techniques are uniquely effective in treating particular disorders (late 1980s and early 1990s). The findings concerned with Categories 4 and 5 are (a) that the conclusion that Rogers's attitudinal conditions are necessary but not sufficient has virtually no direct research support, and (b) that the research concerning specificity of treatment, dysfunction, therapist variables, and client variables is characterized by fragmentation, few replications, and lack of generalizability. Implications of the study indicate that specificity research, driven by the unfounded assertion that Rogers' attitudinal conditions are not sufficient, have yielded inconclusive and misleading findings. The pattern of research is one that culminates in the picture of a self-fulfilling model driven and directed by the “scientificating” deterministic view of human behavior, the movement toward narrow and specific application. Over four decades, the major thread in psychotherapy efficacy research is the presence of the therapist attitudes hypothesized by Rogers.