Where oh where are the specific ingredients? A meta-analysis of component studies in counseling and psychotherapy.

Abstract

Component studies, which involve comparisons between a treatment package and the treatment package without a theoretically important component or the treatment package with an added component, use experimental designs to test whether the component is necessary to produce therapeutic benefit. A meta-analysis was conducted on 27 component studies culled from the literature. It was found that the effect size for the difference between a package with and without the critical components was not significantly different from zero, indicating that theoretically purported important components are not responsible for therapeutic benefits. Moreover, the effect sizes were homogeneous, which suggests that there were no important variables moderating effect sizes. The results cast doubt on the specificity of psychological treatments.It was established in the 1980s that counseling and psychotherapy are remarkably efficacious (Lambert & Bergin, 1994;Wampold, 2000); now on center stage is the controversy about whether the beneficial effects of counseling and psychotherapy are due to the specific ingredients of the treatments or to the factors common in all therapies (Wampold, 2000). On one side are the advocates of empirically supported treatments who claim that treatments are analogues of medical treatments in that efficacy is attributed to their respective specific ingredients, which are usually presented in treatment manuals (see, e.g., Chambless & Hollon, 1998;Chambless et al., 1996;Crits-Christoph, 1997; DeRubeis & CritsChristoph, 1998;DeRubeis & Feeley, 1990; Task Force on Promotion and Dissemination of Psychological Procedures, 1995;Waltz, Addis, Koerner, & Jacobson, 1993;Wilson, 1996). Specificity (i.e., attributing outcome to specific ingredients) is one of the hallmarks of the medical model. On the other side are the advocates of models that stipulate that the common factors, such as the healing context, the working alliance, and belief in the rationale for treatment and in the treatment itself, are the important therapeutic aspects of counseling and psycho-

How does psychotherapy influence personality? A theoretical integration

“…Contemporary research suggests that about 45% of the variance of therapy outcomes is due to general factors of the therapeutic relationship (Lambert, 1992). By contrast, about 15% of the differences among therapeutic outcomes is due to specific theoretical approaches, although recent analyses sometimes put the specific effects lower still (Ahn & Wampold, 2001;Lambert, 1992). The remaining variance is due to client and chance factors (Krupnick et al, 1996).…”

Narrative risks in science writing for the lay public

“…Therapy, Spence [1984] and Totman [1979] amongst others argue, involves the creation of a narrative sufficiently compelling for the patient to enter into, where the match between the story and the 'listener' is more important than the truth of the tale. In a meta-analysis of psychotherapy 'component studies', that is, studies that pit a specific treatment against a treatment package without a component known or assumed to have therapeutic benefit, Ahn and Wampold [2001] found the "critical components" of key therapries did not have power significantly different from zero. They suggest the reasons is not that therapies are useless, but that there are useful elements common to all therapies.…”

Iom Report on Psychosocial Interventions for Mental and Substance Use Disorders: The Interpersonal Psychotherapy Perspective

“…The report recommends that research be conducted to identify and validate "elements" of psychosocial interventions, defined as "therapeutic activities, techniques, or strategies" (p. 3-1). The au-thors argue that this approach could be used to "establish optimal sequencing and dosing of elements" and "connect elements more precisely to purported mechanisms of change than is the case with an entire complex psychosocial intervention" (p. [3][4][5]. Unfortunately, little evidence supports the notion that multifaceted treatments will benefit from deconstruction or retain efficacy when disassembled.…”

“…Studies do not support the hypothesis that psychotherapy elements are independently "active." Meta-analyses of dismantling trials (studies wherein investigators compare a treatment to the treatment minus an integral component) have not found effect sizes that differ significantly from zero [3,4] and effect sizes for additive studies (comparing a treatment to the treatment plus an element) are so small (d = .14) that clinical significance is very unlikely. [4] Thus, although the notion of identifying, separating, and recombining core elements to discover new brain circuits or improve outcomes is intellectually appealing, the extant evidence does not support the feasibility or efficacy of this methodology.…”