The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work
Also known as The Great Psychotherapy Debate, The Great Psychotherapy Debate (2nd ed.), The Great Psychotherapy Debate: Models, Methods, and Findings
Wampold and Imel's case that therapy heals through context and relationship, not technique
At a glance
What it argues
Two models of why therapy works, The Contextual Model, Therapies differ little …
See all 5Chapters
1. History of Medicine, Methods and Psychotherapy, 2. The Contextual Model, 3. Contextual Model Versus Medical Model …
See all 9Criticism and limits
Meta-analyses can mislead, CBT may be better for some problems, Common factors theory under fire
See all 3Read next
How important are the common factors in psychotherapy? An update, The alliance in adult psychotherapy: a meta-analytic synthesis, The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses …
See all 4Connections
Bruce Wampold, Zac E. Imel and 4 others
See all 6
Also on this page: Key facts · Links · Sources · Related pages
- The book asks why psychotherapy works: through each treatment's specific techniques, or through what all therapies share.
- It contrasts a medical model, where specific ingredients fix specific disorders, with the authors' Contextual Model.
- The Contextual Model treats therapy as a healing practice shaped by its social context.
- From meta-analyses it argues that bona fide therapies differ little in outcome, while therapists differ a lot.
- It reviews the evidence for common factors such as the alliance, expectations and empathy.
Why it matters
- For anyone choosing a therapy, a training or a therapist: it is the main evidence-based case that the relationship and the therapist matter more than the brand of therapy.
- Read it with its critics, who argue some treatments do beat others.
Key facts
- Authors
- Bruce E. Wampold and Zac E. Imel (2nd edition); Bruce E. Wampold alone (1st edition)1
- Published
- 2015 (2nd edition); 1st edition 20011
- Publisher
- Routledge (2nd edition); Lawrence Erlbaum, LEA's Counseling and Psychotherapy Series (1st edition)1
- First edition title
- The Great Psychotherapy Debate: Models, Methods, and Findings (2001)2
- Pages
- 334, with 25 black-and-white illustrations (2nd edition)1
- ISBN
- 978-0-8058-3202-0 (1st edition, paperback)2
- New in the 2nd edition
- An expanded Contextual Model, a history of healing practices, medicine and psychotherapy, and a chapter on therapist effects1
- Reception
- Scott D. Miller called it "one, if not the most, important book ever published about psychotherapy" (publisher's page)1
What it argues
-
Two models of why therapy works1
A medical model says specific ingredients treat specific disorders; the Contextual Model says therapy is a socially situated healing practice.
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The Contextual Model3
An initial bond comes first, then three pathways: a real relationship, expectations created by a believable explanation, and specific ingredients that prompt healthy actions.
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Therapies differ little1
Chapter 5, "Relative Efficacy: The Dodo Bird Still Gets It", argues that comparisons of bona fide therapies find small differences.
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Therapists differ a lot1
Chapter 6 treats therapist effects as an ignored but critical factor: who delivers therapy matters, not only which therapy.
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Where are the specific effects?3
Chapter 8 asks whether the specific techniques of a treatment add measurable benefit; Wampold's 2015 update puts most treatment differences at about d = 0.20 or less.
Chapters
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1. History of Medicine, Methods and Psychotherapy1
Progress and omissions.
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2. The Contextual Model1
Psychotherapy as a socially situated healing practice.
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3. Contextual Model Versus Medical Model1
Choosing a progressive research programme.
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4. Absolute Efficacy1
The benefits of psychotherapy established by meta-analysis.
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5. Relative Efficacy1
The Dodo bird still gets it.
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6. Therapist Effects1
An ignored but critical factor.
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7. General Effects1
Surviving challenges and anticipating additional evidence.
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8. Specific Effects1
Where are they?
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9. Beyond the Debate1
Implications of the research synthesis for theory, policy and practice.
Criticism and limits
-
Meta-analyses can mislead4
Critics call Dodo-bird meta-analyses agenda-driven; Paul Crits-Christoph noted that 79 of 114 studies in Wampold's 1997 analysis involved similar comparisons.
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CBT may be better for some problems4
Hunsley (2007): when measurement quality is controlled, cognitive and behavioral treatments come out ahead for a wide range of conditions.
-
Common factors theory under fire5
Critics say it dismisses specific techniques, reduces to a good relationship, or is not scientific; supporters reply that a coherent treatment is the medium for common factors.
Read next
-
How important are the common factors in psychotherapy? An update
Wampold's 10-page summary of the same evidence, with the effect sizes.
-
The alliance in adult psychotherapy: a meta-analytic synthesis
The largest test of the alliance-outcome link, co-written by Wampold.
-
The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses
The other side: the evidence base for one specific therapy.
-
The efficacy of psychodynamic psychotherapy
Shedler's case that a supposedly unproven therapy matches the evidence-based ones.
Connections
Written by
- Bruce WampoldPerson
- Zac E. Imel
Related
- Common factors theoryTopicThe book's central evidence for common factors
- Dodo bird verdictTopicChapter 5 defends the verdict that bona fide therapies do about equally well
- Therapeutic allianceTopicOne of the common factors it reviews
- Evidence-based practice in psychologyTopicArgues against judging therapies only by their specific ingredients
Links
Sources
- The Great Psychotherapy Debate, 2nd edition (Routledge) (opens routledge.com)
- The Great Psychotherapy Debate, 1st edition (Open Library) (opens openlibrary.org)
- Wampold BE. How important are the common factors in psychotherapy? An update. World Psychiatry 2015 (PMC) (opens pmc.ncbi.nlm.nih.gov)
- Dodo bird verdict (Wikipedia) (opens en.wikipedia.org)
- Common factors theory (Wikipedia) (opens en.wikipedia.org)
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