For a number of years, debates have been rampantly widespread about the way we do therapy, what it is about therapy that works. Since Rosenzweig in 1936 first raised this issue, psychoanalysts debated through clinical case studies what was effective and first coined the now famous dodo bird verdict. This, some years later led to the issues raised first in 1975 by Luborsky in his paper with the famous Alice in Wonderland quote. More recently, it has become commonplace to re-augment the scientific approach to establishing effectiveness through randomised control trials. Clearly, there is good reasoning for this as these trials have to be conducted in environments that can exclude many variables and rely on delivering a therapy from a manual in order to try to deliver conformity. However, we know that these types of therapy are less effective in naturalistic settings. However, it remains important to try to know what it is that we are doing….but we still do not really know what part of what we are doing is the effective part. Common factors approaches tried to establish what are those aspects of therapy that are common to all therapies that are effective. Yet the war rages on.
This post comments on the graphical representation of aspects of therapy demonstrated by Lambert’s Pie. What this shows is that only a small proportion of effectiveness is due to technique, another small proportion is due to expectation and placebo. The two largest segments of the pie are due to relational factors and the most significant slice relates to what are known as client-attributable or context-related factors.
Miller and Hubble wrote an important contribution called the Heart and Soul of Change and Schneider provided an erudite treatment in his two editions of Existential Humanistic Therapy. Only Ernesto Spinelli has in recent years provided a framework for the delivery of existential therapy. The profession however as well pointed out by Jeffery Smith continues to do battle over modality, professional status and diagnosis as a number of books by prominent psychiatrists try to dissemble the vast array of confusing labels.
Our form of existential-phenomenological humanistic therapy recognises the need to measure whether some type of therapy is effective and tries to manage the tension in allowing for creativity, flexibility and individuality in therapy while retaining an element of operationalization of the process in order that we can assert with a degree of assurance that the interventions that we are delivering are measurable and contain elements that are effective.
Therefore, we have designed and tested a form of therapy that focuses primarily upon the qualities of the therapeutic relationship and empowering the client, in order that those factors in the pie are ignited and that the therapy may be more successful, whilst being measurable and informed by existential attitudes, a phenomenological method and humanistic principles, in order to address the breadth of human experience, challenge the medical model and stigma associated with psychological difficulties.