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COMMENTARY
Evidence-Based Psychological Interventions and the Common Factors
Approach: The Beginnings of a Rapprochement?
Stefan G. Hofmann and David H. Barlow
Boston University
Laska, Gurman, and Wampold (2014, pp. 467–481) argue that common factors (CFs) have largely been
ignored by clinical researchers developing research-based interventions but that CFs are primarily
responsible for therapeutic change. On the contrary, many clinical researchers developing empirically
supported treatments have been studying the contribution of these factors for decades. What has been
demonstrated is that these factors are contributory, but are not sufficient to produce maximum effects and
their impact differs greatly from disorder to disorder. But we also take note of a change of tone and
perhaps substance from these authors on the contribution of CFs to evidence-based psychological
interventions, and reflect on recent changes in our own views both of which may reduce differences in
our respective positions.
Keywords: common factors, nonspecific factors, empirically supported treatments, Dodo bird, therapist
factor
We read with great interest the article by Laska, Gurman, and
Wampold (2014, pp. 467–481) and, as always, appreciate the
opportunity to comment. Although both of us have engaged in this
interesting exercise from time to time, one of us (D.H.B.) has been
periodically involved for ⬎20 years. In the most recent period, the
individual most often waving the common factor (CF) banner has
been Dr. Bruce Wampold who is always a scholar and a gentleman
in these interchanges. Thus, it is a pleasure to grapple with these
issues whether in print or in person and we welcome the views of
Doctors Laska and Gurman. But before jumping into the breach
once again to add new data in support of oft-made arguments, it
seems appropriate to step back and offer a 2014 perspective on this
long running debate, as this perspective seems to reflect changes,
some of them perhaps quite fundamental, in both positions. So,
Laska et al. (2014), write that there are empirically supported
treatments (ESTs) with specific active ingredients such as
exposure-based procedures that would be clearly indicated for
some disorders but not for others; that ESTs should be dissemi-
nated; and that CFs such as patient expectancies and alliance may
contribute to their efficacy. We could end our commentary here
and simply say “amen” but this might disappoint the readers of this
discussion, so let’s look a bit more closely at what is now being
said.
First, from the CF position the definition of “bona fide” seems
to be tightening. Thus, we learn in this article that “supportive
psychotherapy” is clearly excluded from this definition and pre-
sumably, as the authors specifically disavow the “anything goes”
characterization of effective psychotherapy, other less structured
approaches such as exploratory psychotherapy and open-ended
relatively nonspecific long-term approaches would also be ex-
cluded. We see this as a positive development, and we challenge
the authors to be even more specific in delineating types of
practices that would not be considered “bona fide.” We encour-
age this not only to sharpen the debate but also to begin to move
away from the message received by many that everyone who
receives any kind of psychotherapy achieves “commendable
and desirable outcomes” without any further characterization of
who or what was treated as mentioned in Laska et al. (2014),
and also exemplified in the recent unfortunate political state-
ment that strove to incorporate all offered views on psychother-
apy but ended up reflecting few of them with integrity (Camp-
bell, Norcross, Vasquez, & Kaslow, 2013). We believe this
position is dangerous because it is not the case. Many individ-
uals, particularly those suffering from certain forms of psycho-
pathology (e.g., schizophrenia, obsessive–compulsive disorder)
are relatively nonresponsive to some psychological interventions
albeit more responsive to some than to others (Barlow, 2014). Our
guess is that our colleagues in this debate would also not want to
encourage the type of complacency that would allow all practitio-
ners to exercise their confirmatory biases and adopt this “anything
goes” position whether the psychotherapy met criteria for “bona
fide” or not with regard to individuals suffering from various
forms of psychopathology severe enough to meet criteria for a
disorder. And it flies in the face of clinical experience let alone the
research evidence that exactly the same therapeutic approach
This article was published Online First August 11, 2014.
Stefan G. Hofmann and David H. Barlow, Department of Psychology,
Boston University.
S.G.H. is supported by NIMH grant R01 AT007257; D.H.B. is sup-
ported by NIMH grant R01 MH090053.
Correspondence concerning this article should be addressed to Stefan G.
Hofmann, Department of Psychology, Boston University, 648 Beacon
Street, 6th Floor, Boston, MA 02115. E-mail: shofmann@bu.edu
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