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 Clinical Psychology) 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 Boston University. 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.
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