Edited by
Stefan G. Hofmann
Joel Weinberger
Contents
About the Editors ix
Contributors xi
The Art and Science of Psychotherapy: An Introduction xvii
Stefan G. Hofmann and Joel Weinberger
SECTION I Theoretical Issues
1 Discovering What Works in the Community:
Toward a Genuine Partnership of Clinicians and Researchers........ 3
Drew Westen
2 Methodcentric Reasoning and the Empirically Supported
Treatment Debates.......................................................................... 31
Mark A. Blais and Mark J. Hilsenroth
3 An Integrative, Principle-Based Approach to Psychotherapy........ 49
John E. Pachankis and Marvin R. Goldfried
4 Efficacy, Effectiveness, and the Clinical Utility of
Psychotherapy Research................................................................. 69
Peter E. Nathan
5 The Local Clinical Scientist........................................................... 85
George Stricker
SECTION II Nonspecific and Common Factors
6 Empirically Supported Common Factors..................................... 103
Joel Weinberger and Cristina Rasco
7 Toward the Integration of Technical Interventions,
Relationship Factors, and Participants Variables..........................131
David Clinton, Elaine Gierlach, Sanno E. Zack,
Larry E. Beutler, and Louis G. Castonguay
8 Alliance Ruptures: Theory, Research, and Practice.................... 155
Karyn D. Ruiz-Cordell and Jeremy D. Safran
9 Understanding and Working with Resistant Ambivalence in
Psychotherapy: An Integrative Approach.....................................171
Hal Arkowitz and David Engle
SECTION III Treatments of Axis I Disorders
10 General Principles for the Treatment of Emotional Disorders
Across the Lifespan...................................................................... 191
Jill T. Ehrenreich, Brian A. Buzzella, and David H. Barlow
11 The Art of Evidence-Based Treatment of Trauma Survivors.......211
Brett T. Litz and Kristalyn Salters-Pedneault
SECTION IV Treatments of Axis II Disorders
12 Personality Diagnosis with the Shedler-Westen
Assessment Procedure (SWAP): Bridging the Gulf Between
Science and Practice..................................................................... 233
Jonathan Shedler
13 The “Art” of Interpreting the “Science” and the “Science” of
Interpreting the “Art” of the Treatment of Borderline
Personality Disorder..................................................................... 269
Kenneth N. Levy and Lori N. Scott
Conclusions Let a Hundred Flowers Bloom; Let One Hundred Schools of
Thought Contend.......................................................................... 301
Joel Weinberger and Stefan G. Hofmann
Index.................................................................................................................. 307
Psychotherapy is an art and a science. It is a science because therapeutic techniques
should be empirically supported and rooted in falsifiable models of the
psychological problem that is being treated. Psychotherapy is also an art because
these techniques need to be applied flexibly and creatively to a specific person.
Therefore, an effective therapist needs to be knowledgeable in the science of
psychotherapy
while at the same time being able to apply the techniques artfully
to a specific client and problem.
Nevertheless, our discipline is divided. Some clinicians have developed
specific and protocolized interventions to modify the problem behaviors and
distress
associated with a particular diagnosis. Some have conducted randomized
controlled
trials to examine the relative efficacy of a study treatment compared to
a control condition. The treatments that follow this efficacy approach have been
termed empirically supported treatments or ESTs, and have been held to represent
the science aspect of psychotherapy.
The EST movement has been highly controversial. Opponents of this movement
criticize it because they believe that a number of important variables are
ignored that are considered central for conducting effective psychotherapy are
ignored. These variables, which are often associated with what many see as
the art of psychotherapy, include common factors, such as the client-therapist
relationship and other aspects of treatment that cut across or are common to
the different kinds of psychotherapy.
Additionally, common factors such as the
therapeutic relationship
can be studied scientifically so that the EST movement
does not have a monopoly
on science. Similarly, ESTs need to be and usually are
applied flexibly
and creatively.
They therefore have what can be considered an
artistic component, as we have defined it. So what we have called science (ESTs)
and art (relationship and common factors), in accordance with how they are often
seen in the literature,
actually contain aspects of both. This, we believe, has led
to some of the acrimony
between the two as EST supporters insist that they are
not advocating rigid adherence to technique and common factor supporters resent
their points being referred to as nonspecific and/or nonscientific.
An effective clinician, whether she supports the EST or common factor/therapeutic
relationship approach, needs to be both an artist and a scientist. A good
therapist needs to have knowledge about specific treatment strategies in order
to treat a particular problem and also needs to be able to create the appropriate
relationship
with the patient and make use of common factors in order to treat a
particular
person. Although these two sets of skills are not in the least incompatible,
the field of clinical psychology is split into researchers and scholars who approach
psychological problems similar to medical conditions to develop disorder-specific
treatment techniques in efficacy studies, or who focus on effectiveness, common
factors, and the study of the process of psychotherapy.
Managed health care has further polarized these two groups, which has led
to heated debates around the report by the APA Division 12 (Society of ClinicalPsychology)
Task Force on Promotion and Dissemination of Psychological
Procedures.
In an effort to identify problems in the dissemination of psychological
interventions, this Task Force constructed a list of efficacious treatments
(empirically
supported treatments) for various mental disorders, including anxiety,
depression, substance use problems, and personality disorder (e.g., Chambless
& Hollon, 1998). In an effort to offer an alternative to the recommendations of this
Task Force, Division 29 (Division of Psychotherapy) of the APA formed its own
Task Force on Empirically Supported Therapy Relationships with the objective
to identify effective elements of the therapy relationship (empirically supported
relationships, ESR) and to determine effective means of tailoring them to the
individual patient (e.g., Norcross, 2002).
Whereas previous books have sufficiently identified and summarized selected
empirically supported treatments, including a recently published volume co-edited
by one of us (Hofmann & Tompson, 2002), little attempt has been made to summarize
so-called unspecific and common factors in psychotherapy. The goal of
this book is to facilitate communications between these two schools of thought,
to synthesize the two practice guidelines described by Divisions 12 and 29, and
to provide clinicians with balanced training in specific treatment technique and
general therapy skills.
The two editors of this book are associated with each of the two opposing
camps: Stefan G. Hofmann has been trained as a clinical scientist, has been
conducting
clinical trials in anxiety disorders, and has been teaching a seminar
entitled “Empirically Supported Treatments for Psychological Disorders at BostonUniversity.
Joel Weinberger is a psychodynamically oriented scholar, teacher, and
clinician who believes that common factors are essential for effective
psychotherapy.
We believe that our differences are complementary, not incompatible.
We hope we
represent an example for future EST/ESR alliances.
The text consists of 13 chapters organized into four main sections: (I) Theoretical
Issues, (II) Nonspecific and Common Factors, (III) Treatments of Axis I
disorders, and (IV) Treatments of Axis II disorders. All chapters were written by
experts in the respective fields with a clear emphasis on the practical relevance and
how to aspect of therapy. In order to achieve this goal, we asked our contributors
to include case examples and patient-client dialogues whenever feasible.
Our hope is that this text not only facilitates communications between these
schools of thought, but also that the combined expertise from these two movements
will benefit those who matter the most in this debate: our patients.
References
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies.
Journal
of Consulting and Clinical Psychology, 66, 7–18.
Hofmann, S. G., & Tompson, M. C. (Eds.) (2002). Treating chronic and severe mental disorders:
A handbook of empirically supported interventions. New York: Guilford Press.
Norcross, J. C. (2002). Psychotherapy relationships that work: Therapist contributions
and responsiveness to patients. New York: Oxford University Press
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Stefan G. Hofmann
Joel Weinberger
Contents
About the Editors ix
Contributors xi
The Art and Science of Psychotherapy: An Introduction xvii
Stefan G. Hofmann and Joel Weinberger
SECTION I Theoretical Issues
1 Discovering What Works in the Community:
Toward a Genuine Partnership of Clinicians and Researchers........ 3
Drew Westen
2 Methodcentric Reasoning and the Empirically Supported
Treatment Debates.......................................................................... 31
Mark A. Blais and Mark J. Hilsenroth
3 An Integrative, Principle-Based Approach to Psychotherapy........ 49
John E. Pachankis and Marvin R. Goldfried
4 Efficacy, Effectiveness, and the Clinical Utility of
Psychotherapy Research................................................................. 69
Peter E. Nathan
5 The Local Clinical Scientist........................................................... 85
George Stricker
SECTION II Nonspecific and Common Factors
6 Empirically Supported Common Factors..................................... 103
Joel Weinberger and Cristina Rasco
7 Toward the Integration of Technical Interventions,
Relationship Factors, and Participants Variables..........................131
David Clinton, Elaine Gierlach, Sanno E. Zack,
Larry E. Beutler, and Louis G. Castonguay
8 Alliance Ruptures: Theory, Research, and Practice.................... 155
Karyn D. Ruiz-Cordell and Jeremy D. Safran
9 Understanding and Working with Resistant Ambivalence in
Psychotherapy: An Integrative Approach.....................................171
Hal Arkowitz and David Engle
SECTION III Treatments of Axis I Disorders
10 General Principles for the Treatment of Emotional Disorders
Across the Lifespan...................................................................... 191
Jill T. Ehrenreich, Brian A. Buzzella, and David H. Barlow
11 The Art of Evidence-Based Treatment of Trauma Survivors.......211
Brett T. Litz and Kristalyn Salters-Pedneault
SECTION IV Treatments of Axis II Disorders
12 Personality Diagnosis with the Shedler-Westen
Assessment Procedure (SWAP): Bridging the Gulf Between
Science and Practice..................................................................... 233
Jonathan Shedler
13 The “Art” of Interpreting the “Science” and the “Science” of
Interpreting the “Art” of the Treatment of Borderline
Personality Disorder..................................................................... 269
Kenneth N. Levy and Lori N. Scott
Conclusions Let a Hundred Flowers Bloom; Let One Hundred Schools of
Thought Contend.......................................................................... 301
Joel Weinberger and Stefan G. Hofmann
Index.................................................................................................................. 307
Psychotherapy is an art and a science. It is a science because therapeutic techniques
should be empirically supported and rooted in falsifiable models of the
psychological problem that is being treated. Psychotherapy is also an art because
these techniques need to be applied flexibly and creatively to a specific person.
Therefore, an effective therapist needs to be knowledgeable in the science of
psychotherapy
while at the same time being able to apply the techniques artfully
to a specific client and problem.
Nevertheless, our discipline is divided. Some clinicians have developed
specific and protocolized interventions to modify the problem behaviors and
distress
associated with a particular diagnosis. Some have conducted randomized
controlled
trials to examine the relative efficacy of a study treatment compared to
a control condition. The treatments that follow this efficacy approach have been
termed empirically supported treatments or ESTs, and have been held to represent
the science aspect of psychotherapy.
The EST movement has been highly controversial. Opponents of this movement
criticize it because they believe that a number of important variables are
ignored that are considered central for conducting effective psychotherapy are
ignored. These variables, which are often associated with what many see as
the art of psychotherapy, include common factors, such as the client-therapist
relationship and other aspects of treatment that cut across or are common to
the different kinds of psychotherapy.
Additionally, common factors such as the
therapeutic relationship
can be studied scientifically so that the EST movement
does not have a monopoly
on science. Similarly, ESTs need to be and usually are
applied flexibly
and creatively.
They therefore have what can be considered an
artistic component, as we have defined it. So what we have called science (ESTs)
and art (relationship and common factors), in accordance with how they are often
seen in the literature,
actually contain aspects of both. This, we believe, has led
to some of the acrimony
between the two as EST supporters insist that they are
not advocating rigid adherence to technique and common factor supporters resent
their points being referred to as nonspecific and/or nonscientific.
An effective clinician, whether she supports the EST or common factor/therapeutic
relationship approach, needs to be both an artist and a scientist. A good
therapist needs to have knowledge about specific treatment strategies in order
to treat a particular problem and also needs to be able to create the appropriate
relationship
with the patient and make use of common factors in order to treat a
particular
person. Although these two sets of skills are not in the least incompatible,
the field of clinical psychology is split into researchers and scholars who approach
psychological problems similar to medical conditions to develop disorder-specific
treatment techniques in efficacy studies, or who focus on effectiveness, common
factors, and the study of the process of psychotherapy.
Managed health care has further polarized these two groups, which has led
to heated debates around the report by the APA Division 12 (Society of ClinicalPsychology)
Task Force on Promotion and Dissemination of Psychological
Procedures.
In an effort to identify problems in the dissemination of psychological
interventions, this Task Force constructed a list of efficacious treatments
(empirically
supported treatments) for various mental disorders, including anxiety,
depression, substance use problems, and personality disorder (e.g., Chambless
& Hollon, 1998). In an effort to offer an alternative to the recommendations of this
Task Force, Division 29 (Division of Psychotherapy) of the APA formed its own
Task Force on Empirically Supported Therapy Relationships with the objective
to identify effective elements of the therapy relationship (empirically supported
relationships, ESR) and to determine effective means of tailoring them to the
individual patient (e.g., Norcross, 2002).
Whereas previous books have sufficiently identified and summarized selected
empirically supported treatments, including a recently published volume co-edited
by one of us (Hofmann & Tompson, 2002), little attempt has been made to summarize
so-called unspecific and common factors in psychotherapy. The goal of
this book is to facilitate communications between these two schools of thought,
to synthesize the two practice guidelines described by Divisions 12 and 29, and
to provide clinicians with balanced training in specific treatment technique and
general therapy skills.
The two editors of this book are associated with each of the two opposing
camps: Stefan G. Hofmann has been trained as a clinical scientist, has been
conducting
clinical trials in anxiety disorders, and has been teaching a seminar
entitled “Empirically Supported Treatments for Psychological Disorders at BostonUniversity.
Joel Weinberger is a psychodynamically oriented scholar, teacher, and
clinician who believes that common factors are essential for effective
psychotherapy.
We believe that our differences are complementary, not incompatible.
We hope we
represent an example for future EST/ESR alliances.
The text consists of 13 chapters organized into four main sections: (I) Theoretical
Issues, (II) Nonspecific and Common Factors, (III) Treatments of Axis I
disorders, and (IV) Treatments of Axis II disorders. All chapters were written by
experts in the respective fields with a clear emphasis on the practical relevance and
how to aspect of therapy. In order to achieve this goal, we asked our contributors
to include case examples and patient-client dialogues whenever feasible.
Our hope is that this text not only facilitates communications between these
schools of thought, but also that the combined expertise from these two movements
will benefit those who matter the most in this debate: our patients.
References
Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies.
Journal
of Consulting and Clinical Psychology, 66, 7–18.
Hofmann, S. G., & Tompson, M. C. (Eds.) (2002). Treating chronic and severe mental disorders:
A handbook of empirically supported interventions. New York: Guilford Press.
Norcross, J. C. (2002). Psychotherapy relationships that work: Therapist contributions
and responsiveness to patients. New York: Oxford University Press
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