Dodo Bird’s Effect

Running head: DODO BIRD’S EFFECT

Dodo Bird’s Effect: Common Therapeutic Factors in Psychotherapy

Reaction Paper 3

Komal Mohan

CPSY 710
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For those convinced of the singular abilities of their models and related interventions, the

results have been disappointing. As therapy research has evolved, some researchers have taken a

closer look at the common components of the various approaches rather than comparing different

orientations/ theories of psychotherapy. This paper addresses the definition and aim of common

factors and their importance based on empirical studies while outlining what they are across the

many brief therapies and what are some of the limitations of this thought process.

Common factors are those dimensions of the treatment setting (therapist, therapy, client)

that are not specific to any particular technique. The term common factors is suggested as a

replacement for terms like placebo (Rosenthal and Frank, 1956) and nonspecific factors (Oie &

Shuttlewood, 1996), in recognition that many therapies have ingredients that are not unique but

are nonetheless efficacious. Thus, research on placebo effects might be better conceptualized as

research on common factors versus the specific effects of a particular and unique technique

(Lambert, 2005). The aim of common factors is to determine the core ingredients that different

therapies share, with the eventual goal of creating more parsimonious and efficacious treatments

based on those commonalities. Common factors, no matter how unimportant they may be from

the point of view of a particular theory are central to nearly all psychological interventions in

practice. As Marvin Goldfried (1980) lamented, far too often in psychotherapy we speak of who

is correct rather than what is correct. Common factors are not located solely in the therapist, but

also in the client; not solely in the intra-therapy alliance, but also in the broader environmental

context (including managed care); not solely in formal treatment, but also as part of clients' self-

change.

Lambert, Weber, and Sykes (1993) summarized studies comparing the effect sizes of

psychotherapy, placebo, and no-treatment controls. The results the average client undergoing a
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placebo treatment is better off than 66% of the notreatment controls. On the other hand, the

average client undergoing psychotherapy is better off than 79% of the no-treatment controls

specific techniques are estimated to account for only about 15% of the improvement in

psychotherapy clients (Lambert, 1992).

Common therapeutic factors can be divided into four broad areas: client factors and

extra-therapeutic events, relationship factors, expectancy and placebo effects, and

technique/model factors. Lambert (1992) concluded that as much as 40% of the improvement in

psychotherapy clients is attributable to client variables and extra-therapeutic influences. These

spontaneous remissions of clients improving without formal psychotherapeutic interventions

highlights the importance of supportive and therapeutic aspects of the natural environment in

which clients live and function. For instance help from friends, family, teachers, clergy, self help

literature/ groups bears mentioning. The second common factor is that of relationships, which

account for approximately 30% of client improvement (Lambert, 1992). Rogerian psychotherapy

states that certain necessary and sufficient relationship conditions are necessary (empathy,

positive regard, and genuineness) for change to occur in a client. WRITE HERE OF THE

OTHER THERAPIES In can be concluded that therapists are differentiated almost entirely by

nonspecific (relationship) factors rather than specific (technical) factors.

The third common factor as per Lambert (1992) is expectancy effect, which accounts for

15% of the variance in client change. WRITE HERE OF THE OTHER THERAPIES Frank

(1973) argued that the therapeutic enterprise carries the strong expectation that the client will, in

fact, be helped. Underlying factor unites all the seemingly different approaches to

psychotherapy. The forth common factor is specific techniques which are estimated to account

for only about 15% of the improvement in psychotherapy clients (Lambert, 1992). As the use of
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therapy manuals becomes more frequent there will be a reduction in the variability in outcome

by allowing for more accurate comparisons in comparative outcome studies. The use of and

adherence to treatment manuals also helps enhance the effects of specific therapy procedures

(Crits-Christoph, 1992).

Conclusion :

From this perspective, the study confirms the “Dodo bird verdict”—all have won so all

must have prizes. Indeed, had the study included a cognitive-therapy-only group, the

experimenters may have found that the CT-only treatment group also improved. While the

results of studies that use placebo controls suggest that psychotherapists are not merely

“placebologists,” the placebo control group is only one of many methods aimed at isolating the

presumed causes of patient improvement. In fact, the placebo control group has been largely

replaced by other control groups that overcome the conceptual and ethical dilemmas associated

with their use.

The contributors concur that more than commonalities are evident

across the therapies: There are unique or specific factors attributable

to different therapies as well. One of the seminal achievements

of psychotherapy research, as Asay and Lambert note in chapter 2, is

the demonstration of the differential effectiveness of psychotherapies

with specific disorders (e.g., behavior therapy for child conduct disorders,

conjoint therapy for marital conflict, and cognitive therapy for

panic disorder). Psychotherapies are also differentially effective with

clients at different stages of change, as Prochaska notes in chapter 8,

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and with clients of different personalities and goals, as other contributors

note. Effective clinicians will thus implement those factors common

across therapies while capitalizing on the contributions of specific

techniques.

Further older meta-analytic reviews of this research literature generally have shown small

effect size differences between comparison groups (e.g., Durlak, 1979; Hattie, Sharpley, &

Rogers, 1984). of More and Less Trained Therapists, which shows that positive patient outcomes

occur with and without training in specific therapeutic therapy techniques (Lambert, 2005).

Research on the broader concept of common factors investigates causal mechanisms such as

expectation for improvement, therapist confidence, and a therapeutic relationship that is

characterized by trust, warmth, understanding, acceptance, kindness, and human wisdom. But

also can be expanded to include some mechanisms that are often regarded as unique to a

particular form of treatment such as exposure to anxiety-provoking stimuli, encouragement to

participate in other risk-taking behavior (facing rather than avoiding situations that make the

patient uncomfortable), and encouraging client efforts at mastery such as practicing and

rehearsing behaviors. Such a view of common factors recognizes that while specific theories of

psychotherapy may emphasize systematic in vivo or in vitro exposure to frightening situations,

or social skills training, nearly all therapies encourage people to review and discuss the things

they fear and face rather than avoid such situations (Lambert, 2005).

Limitations/ future research:

Few studies have investigated the timing of response in psychotherapy with the intent of

understanding the active ingredients of treatment and the place of common and unique
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therapeutic factors. This is important because early response may simply indicate a response to

common factors (e.g. a client’s readiness to change) rather than specific interventions (i.e.,

substantial improvement occurs before, not after, most of the specific therapeutic operations have

been initiated). Given the findings on early treatment response, it can be argued that early rapid

response is another piece of evidence for the common factors’ hypothesis, but one that is in need

of further research and improved methodology. Common factors loom large as mediators of

treatment outcome.

References

Durlak, J.A. (1979). Comparative effectiveness of paraprofessional and professional helpers.

Psychological Bulletin, 86, 80–92.

Hattie, J.A., Sharpley, C.F., & Rogers, H.F. (1984). Comparative effectiveness of professional

and paraprofessional helpers. Psychological Bulletin, 95, 534–541.

Lamber, M. J. (2005). Early response in psychotherapy: further evidence for the importance of

common factors rather than “placebo effects”. Journal of Clinical Psychology, 61(&),

855- 869

Oei, T.P.S., & Shuttlewood, G.J. (1996). Specific and nonspecific factors in psychotherapy: A

case of cognitive therapy for depression. Clinical Psychology Review, 16, 83–103.

Rosenthal, D., & Frank, J.D. (1956). Psychotherapy and the placebo effect. Psychological

Bulletin, 53, 294–302.