I was disappointed by the two articles we read this week. I didn't find them nearly as interesting as the past few weeks' readings. I usually I LOVE to talk about relationships. I guess the therapeutic one just doesn't excite me the way gossiping about my friends relationships excites me.
This brings me to the first thing I want to talk about: friendship. The Kirschenbaum and Jourdan (2005) article repeatedly pointed out that "much of the latest research on psychotherapy outcomes has demonstrated that, rather than particular approaches, it is certain 'common factors' in the therapy relationship that account for therapeutic change" (p. 44). These common factors include things such as "warmth, respect, empathy, acceptance and genuineness, positive relationship, and trust" (p. 44). Correct me if I'm wrong, but aren't these characteristics the same things you would expect out of a close friend? I know they are things I expect from my closest friends. So if it is true that different psychological approaches (such as CBT, IPT, etc...) don't matter nearly as much as these "common factors," why go to a therapist? Just go talk to your best friend for a couple of hours. At least you won't have to pay him/her.
Ok, I obviously don't believe that friends should replace therapists. Yet, I wonder if it is possible to teach somebody to have all of these "common factors". Is it possible to teach warmth? Or is it just a trait people either have or don't have? Have there been studies on this? I assume there must be...I just don't know of them.
I'm very surprised that this article repeatedly emphasized that psychology's theoretical schools "seem no better than one another" when common factors are considered, as opposed to stressing the importance of finding out how these common factors can interact with different treatments. I think that would be much more interesting (& important to our field) than what we read in this article.
Research has shown that CBT is better than other treatments for certain disorders (ie, specific phobias). According to Kirschenbaum and Jourdan, I think this would imply that CBT specialists just happen to be better at creating a therapeutic relationship than other types of therapists. I don't buy this. Why would CBT therapists be better at this than other therapists?
Alright...that is enough complaining out of me for this week. See you all on Wednesday.
Oh, on a side note, one of my favorite WashU professors (Richard Kurtz) was cited in this article (on p. 47)! If anybody is at all interested in research on hypnosis, I'd really recommend checking out his work. He does some pretty interesting stuff. And he is one of the most interesting people I've ever met.
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3 comments:
"So if it is true that different psychological approaches (such as CBT, IPT, etc...) don't matter nearly as much as these "common factors," why go to a therapist? Just go talk to your best friend for a couple of hours. At least you won't have to pay him/her."
I think this is a very serious question, with huge implications for our field--particularly when it comes to comparing different forms of psychotherapy. The question you are really raising is: What's the incremental validity of therapy over having a good friend? I think the best answer to this question is, for most people, "not all that #$%@ing much!" Of course, a big part of many of our clients' problems' is that they don't have a good friend.
And you raise another point also, about CBT and phobias. I actually wonder about how necessary therapists are at all for certain types of problems. For example, specific phobias and certain sexual dysfunctions are probably treatable via computer software.
When it comes to more complex problems--personality disorders, mood disorders, substance issues, PTSD, etc...how you deal interpersonally with your client probably does matter, a lot . But I think this may be a more complex point than either article really appreciates in the end.
Here are some examples of things I have told my clients. Are these statements empathetic? Cold and mean? Frank and honest? Warm? What are the relative merits of such interpersonal qualities? Anyway, I have actually said the following:
"You are not my friend, and you never will be. You are a paying customer."
"I am sick of talking with you about this sh--. It feels dishonest."
"So what in the hell is so special about you?"
Therapeutic alliance, or just another crazy therapist run amok? You decide.
I think you touch on some very interesting points in your post here. It is interesting to think about how similar the friendship and therapist relationship is. The key difference for me would be that a lot of friends are capable of giving some pretty awful advice whereas therapists are better trained to give good advice. Good points, and I agree on Kurtz.
-J
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