“Are All Psychological Therapies Equally Effective? Don’t Ask the Dodo”

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The Guardian reviews the hypothesis that all therapies are equal, in light of recent evidence, finding that “. . . we shouldn’t assume that the kind of therapy patients receive is essentially inconsequential. Instead we must recognise that some are better for certain conditions than others.”

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16 COMMENTS

  1. The article reports on the comparison of just TWO different therapies, CBT and psychoanalysis when applied to eating disorders; then generalizes the results to say “So when it comes to psychotherapy, it seems the dodo was wrong.” Second, Rosenzweig’s idea of common factors is not used to say that in all cases, all therapies are equal. Read Barry Duncan’s article, “The Legacy of Saul Rosenzweig: The Profundity of the Dodo Bird” in The Journal of Psychotherapy Integration (2002, vol. 12, no. 1, 32-57); or get a copy of “The Heart and Soul of Change” by Hubble, Duncan and Miller and read the overwhelming evidence that in most cases the type of therapy makes no difference. The author sets up a straw man to then knock down in his article. “The claim that all forms of psychotherapy for mental illness are winners, known as the Dodo Bird Verdict, has been dealt a blow.” This was not what Rosenzweig was claiming. This is not what “The Heart and Soul of Change” was demonstrating.

  2. Guys, I appreciate your perspective (and the links). The Guardian article seemed to have this as its central point: “we must recognise that some are better for certain conditions than others.” The Dodo Bird verdict, in its standard form (e.g., http://en.wikipedia.org/wiki/Dodo_bird_verdict), says that all psychotherapies are equally effective, period, regardless of context. Even one well-established example to the contrary would seem to disprove this general version of the Dodo Bird verdict. There are certainly many cases in which numerous forms of psychotherapy *that have been studied* have been shown of equal effectiveness (I emphasize this caveat because one cannot necessarily generalize the effectiveness of therapies that have been studied to this that have been not). There are also many examples where this is not the case. In my area of research – anxiety – there are many studies showing that some forms of psychotherapy are better than others. More compelling, to me, is that there are many studies showing that certain forms of the same therapy (CBT) are more effective than other forms. To take another example, the efficacy of pill placebo in drug trials varies from one problem to another (http://www.ncbi.nlm.nih.gov/pubmed/?term=placebo+effect+and+huppert+and+barlow). Sometimes, context matters, and the “therapy equivalence”” assumption is wrong. But only sometimes.

    It seems clear that “common factors” are very important in psychotherapy. But it is also clear that for some problems, “common factors therapy” is less effective than other therapies. Online CBT approaches are highly effective for some problems, which is interesting because they involve no relationship between therapist and client. I don’t make these observations to argue against the importance of common factors, but rather to note that sometimes, context matters. Which is the opposite conclusion of the Dodo Bird verdict, in its most popular form. If we are to dilute the Dodo Bird Verdict by defining it as saying, “All therapies are equally effective, except in some circumstances where certain therapies are better than others,” it seems to me we’re robbing it of its meaning (and consequences).

    Best,

    Brett

  3. “Instead we must recognize that some are better for certain conditions than others, redouble our efforts to identify these and improve them, and ensure that the most effective therapies are available to all who need them.”

    I smell a rat rather than a Dodo bird.
    Perhaps agenda – perhaps such as using this and the DSM to deny various psychotherapies to people as is happening.

    Certainly there are harmful therapies. Dr. David Allen uses psychotherapy to effect his vision of social control, I’ve as much as told him he should work for a totalitarian state, he’d get a place well earned.. and Pharma’s talk-therapy ie “support you on drugs” is another anti-therapy.

    Redouble? huh?. Instead of just practicing an effective psychotherapy? None of this sounds right, like directing a neurosis.

    Ah so…
    “The University of Copenhagen recently compared the efficacy of two popular psychotherapies: CBT and psychoanalysis.”

    So they are actually trying to find out which one is better for everybody. Well, yes some methods are better than others and both those methods are low in the scale of effectiveness. And it’s up to the therapist to make it work, not make it fail. I’m not surprised psychoanalysis was the least practical- they lie down and “talk” without working on themselves except by chance – it’s nuts – it’s like 1,000 monkeys with typewriters hoping to write a paragraph…

    Just find one that works and throw away the ones that don’t or absorb eclecticly the practices.

    Perhaps the question should be reverse?
    Will one size fit all?.. or nearly all?
    Yes, I think so, I’m pretty sure I experienced it back in the day where diagnosis was rather irrelevant. In that particular environment – group psychotherapy – there was no restriction on intake as as far as I know and diagnosis was limited to “not currently psychotic”.

    But having not seen anything like the psychotherapy I used to take in the ’70’s evidenced anywhere, I am pretty much convinced that psychotherapy is currently murdered and buried by Pharma or passed away or hiding perhaps somewhere where it costs a lot of money to access.
    I should like to be convinced otherwise, then I could start making some referrals.

    Commenter Sigler was right, it was as simple study and more conclusions drawn than it deserved.
    I think what therapists need to do is throw out the junk absorbed from from social control ideology and pick up on where psychotherapy left off thirty years ago before Pharma’s “Talk therapy ” and it’s accompanying reversal of goals became ascendant.
    ..

  4. The document is great – 861 pages of everything I don’t care about and don’t want to know but probably should know – like an analysis of a big pile of excrement.
    ..
    But don’t get me wrong an excellent job and I guess someone had to do it. Perhaps I’ll keep a copy on a podium or desk somewhere and /or memorize relevant sections when I have to deal with Pharma propagandists or the replicant DNA of such propaganda person to person.
    —>
    But you must, I think deal with patients who are being prescribed medications from elsewhere.
    ..
    Sincerely, I don’t care much about psychiatry, do you have anything on psychotherapy (from yourself or others)? hopefully effective.
    What type of people do you work with in a very general sense diagnostic wise?.

    I don’t now what you are referring to with the “genetic fallacy”, I am just caring about the practical issues in any case.

  5. Most of these comments ignore what I consider to be the most important point: it’s about the relationship (and the therapist-client match) and not the therapeutic modality. A bad CBT therapist isn’t going to help a patient with a specific phobia more than a good psychoanalytic one will.

  6. …except for some problems, where your claim that “the relationship is all that matters” is unequivocally incorrect. Bad vs. good therapists aside, for some problems (certain anxiety problems, for example), therapeutic modality matters tremendously. Even Carl Rogers, champion of relationship-oriented psychotherapy, admitted that this approach doesn’t seem to help clients with schizophrenia.