Early response in psychotherapy: Further evidence for the importance of common factors rather than “placebo effects”

Abstract

Evidence is presented demonstrating that placebo control groups benefit more from psychotherapy than no-treatment control groups but less than patients who receive theory-driven treatments. Through a brief review of the results of comparative outcome studies, studies which compare patient outcomes for those seen by trainees or paraprofessionals versus professional therapists and those which show an early response of a sizable portion of patients, a case is made for the powerful effects of common factors in psychotherapy. The early response phenomenon has proposed another challenge to the unique effects of specific psychotherapies and to the wisdom of emphasizing the causative effects of specific techniques in the treatment of specific disorders.

Patients' Experiences and Perceptions of a Consultative Model Integrative Medicine Clinic: A Qualitative Study

“…Both the psychotherapy and medical-nursing research literatures similarly report that a positive alliance between patient and provider fosters better treatment adherence and clinical outcomes. [39][40][41] When IM contributes to such a favorable alliance, it is likely that outcomes can improve, but further systematic research is required. An important question is whether the IM practitioner is adding factors beyond a humanistic, empowering relationship to the treatment program, a caring experience that another provider might otherwise provide in an optimal healing environment.…”

Focus on Change: Implications for the Understanding and Evaluation of Psychological Interventions

“…One idea is that clients who respond early compared to those who do not, differ in their prior "readiness to change" (Lambert, 2005). Other theories propose that, instead of being a response to specific treatment factors, clients who respond early to therapy can be seen across a number of theoretical orientations, suggesting that common factors across numerous therapies may be responsible, such as the assurance that comes from a supportive relationship, or positive expectations that life will improve (feelings of hopefulness) (Ilardi & Craighead, 1994;Lambert, 2005). This idea stems from the defined period in which this type of improvement occurs: typically prior to the implementation of specific therapeutic techniques, suggesting that it is too soon for their effects to begin taking place.…”

Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research

“…However, a general finding from RCTs for treatment of borderline PD in both adolescent and adult samples (206) and in reviews and metaanalyses of psychotherapy outcome research is that there is often little or no difference in efficacy among various bona fide psychotherapeutic treatments (207)(208)(209)(210); a finding commonly referred to as the Dodo bird verdict (211). Taken together this points toward the importance of common factors, extra-therapeutic factors, and placebo effects (206,(212)(213)(214)(215)(216). It may thus be proposed that some of the most important factors related to effecting change have less to do with the specific techniques promoted by the various schools of psychotherapy and more to do with the core and common elements shared across these various therapies (113,161,170,206,(217)(218)(219).…”