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Psychotherapy research: do we know what works for whom?

  • Peter Fonagy (a1)
Abstract
Summary

Clinical decision-making about suitability for psychological therapies is hampered by limitations of psychotherapy research and our lack of understanding of therapeutic mechanisms. Watzke et al's important randomised controlled study offers apparent validation for clinical judgement in relation to suitability for psychodynamic psychotherapy but also highlights the negative effects of unselected assignment to this type of treatment. Here, I consider why systematic selection for this form of treatment may be important and suggest how the limited effectiveness of psychodynamic therapy for an unselected group of patients may be addressed by more systematic treatment delivery and the ongoing monitoring of intermediate treatment outcomes.

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References
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1 Watzke, B, Rüddel, H, Jürgensen, R, Koch, U, Kriston, L, Grothgar, B, et al. Effectiveness of systematic treatment selection for psychodynamic and cognitive–behavioural therapy: randomised controlled trial in routine mental healthcare. Br J Psychiatry 2010; 197: 96105.
2 Roth, A, Fonagy, P. What Works for Whom? A Critical Review of Psychotherapy Research (2nd edn). Guilford Press, 2005.
3 Sapyta, J, Riemer, M, Bickman, L. Feedback to clinicians: theory, research and practice. J Clin Psychol 2005; 61: 145–53.
4 Kazdin, AE. Understanding how and why psychotherapy leads to change. Psychother Res 2009; 19: 418–28.
5 Wampold, BE. The Great Psychotherapy Debate: Models, Methods, and Findings. Laurence Erlbaum, 2001.
6 Leichsenring, F, Rabung, S. Effectiveness of long-term psychodynamic psychotherapy: a meta-analysis. JAMA 2008; 300: 1551–65.
7 Abbass, A, Kisely, S, Kroenke, K. Short-term psychodynamic psychotherapy for somatic disorders. Systematic review and meta-analysis of clinical trials. Psychother Psychosom 2009; 78: 265–74.
8 Sandell, R, Blomberg, J, Lazar, A. Time matters. On temporal interactions in psychoanalysis and long-term psychotherapy. Psychother Res 2002; 12: 3958.
9 Bateman, AW, Fonagy, P. Randomized controlled trial of outpatient mentalization-based treatment versus structured clinical management for borderline personality disorder. Am J Psychiatry 2009; 166: 1355–64.
10 Abbass, A, Hancock, J, Henderson, J, Kisely, S. Short-term psychodynamic psychotherapies for common mental disorders. Cochrane Database Syst Rev 2006; issue 4: CD004687 (doi 10.1002/14651858.CD004687.pub3).
11 Haggerty, G, Blake, M, Naraine, M, Siefert, C, Blais, M. Construct validity of the Schwartz Outcome Scale–10: comparisons to interpersonal distress, adult attachment, alexithymia, the Five-Factor Model, romantic relationship length and ratings of childhood memories. Clin Psychol Psychother 2010; 17: 4450.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Psychotherapy research: do we know what works for whom?

  • Peter Fonagy (a1)
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eLetters

Psychotherapy research: do we know what works?

Alasdair J Macdonald, Consultant psychiatrist
11 August 2010

Dear Sir,

Professor Fonagy (1) is mistaken: the ‘Dodo Bird’ metaphor is not Wampold’s creation but was devised by Luborsky (2).

The Watzke study (3) randomised some individuals to therapy and referred others on the basis of therapist judgement. In fact Seligman (4)and Wampold (5) have identified that good predictors of outcome in psychotherapy are client choice and client preference for the model offered. The study does not provide information on these points. It is likely that the clients responded to their therapy along these lines whichtherefore obscured any real difference between therapy models.

The IAPT programme also fails to take account of these variables and of therapist preferences. You may conclude that its results will thereforebe less promising than is hoped.

Alasdair Macdonald , SWIFTS Team, Digby Court, Edward Road, Dorchester DT1 2HL, UK. Email: macdonald@solutionsdoc.co.uk

1 Fonagy, P. Psychotherapy research: do we know what works for whom?Br J Psychiatry 2010; 197: 83-85.

2 Luborsky, L. Are Common Factors Across Different Psychotherapies the Main Explanation for the Dodo Bird Verdict That "Everyone Has Won So All Shall Have Prizes"? Clinical Psychology: Science and Practice, 1995; 2: 106 – 109.

3 Watzke, B., Ruddel, H.,Jurgensen, R., Koch, U., Kriston, L., Grothgar, B. and Schultz, H. Effectiveness of systematic treatment selection for psychodynamic and cognitive-behavioural therapy: randomised controlled trial in routine mental healthcare. Br J Psychiatry, 2010; 196: 96-105.

4 Seligman, M.E.P. The effectiveness of psychotherapy. The ConsumerReports study’, American Psychologist, 50: 965-74.

5 Wampold, B.E. The Great Psychotherapy Debate: Models, Methods and Findings. New Jersey: Lawrence Erlbaum Associates 2001.
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