ArticlePublisher preview available

Obtaining Consensus in Psychotherapy: What Holds Us Back?

DOI:10.1037/amp0000365
Authors:
Marvin R. Goldfried
Marvin R. Goldfried
Marvin R. Goldfried
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Although the field of psychotherapy has been in existence for well over a century, it nonetheless continues to be preparadigmatic, lacking a consensus or scientific core. Instead, it is characterized by a large and increasing number of different schools of thought. In addition to the varying ways in which psychotherapy has been conceptualized, there also exists a long-standing gap between psychotherapy research and how it is conducted in actual clinical practice. Finally, there also exists a tendency to place great emphasis on what is new, often rediscovering or reinventing past contributions. This article describes each of these impediments to obtaining consensus and offers some suggestions for what might be done to address them.
  • A preview of this full-text is provided by American Psychological Association.
  • Learn more
Preview content only
Content available from American Psychologist
This content is subject to copyright. Terms and conditions apply.
Obtaining Consensus in Psychotherapy: What Holds Us Back?
Marvin R. Goldfried
Stony Brook University
Although the field of psychotherapy has been in existence for well over a century, it nonetheless
continues to be preparadigmatic, lacking a consensus or scientific core. Instead, it is characterized
by a large and increasing number of different schools of thought. In addition to the varying ways
in which psychotherapy has been conceptualized, there also exists a long-standing gap between
psychotherapy research and how it is conducted in actual clinical practice. Finally, there also
exists a tendency to place great emphasis on what is new, often rediscovering or reinventing past
contributions. This article describes each of these impediments to obtaining consensus and offers
some suggestions for what might be done to address them.
Keywords: therapy alliance, clinical training, practice–research gap, psychotherapy
integration, RDoC
I once had a conversation with a physician where I
lamented about the disjointed nature of the field of psycho-
therapy. I complained that there are many different schools
of thought, with each having its own theoretical view about
the therapy change process; that there exists a long-standing
gap between therapy research and practice; and that instead
of building on past knowledge, we seem to be rediscovering
and/or replacing what we already know. His response was:
“What do you expect of an infant science.” An infant
science? Over 100 years old and still an infant! This was
several years ago, and things have improved since that time;
it might be more accurate to view the field as having moved
into its adolescence. Still, the question is: Why is this the
case? Why haven’t we advanced beyond this point? What
do we need to do in order to move the field of psychother-
apy toward greater maturity? The purpose of this article is to
address these questions, beginning with some of the reasons
for our difficulty in obtaining agreement and moving on to
consider whether it is possible to move the field forward in
reaching some consensus and, if so, how that might be
done.
1
There are at least three problematic issues that seem to
contribute to the difficulty we have in obtaining a consensus
within the field of psychotherapy: The first involves our
long-standing practice of solely working within theoretical
orientations or eclectic combinations of orientations. More-
over, not agreeing with those having other frameworks on
how to bring about therapeutic change results in the prolif-
eration of schools of therapy (Goldfried, 1980). The second
issue involves the longstanding gap between research and
practice, where many therapists may fail to see the rele-
vance to their day-to-day clinical practice and also where
many researchers do not make systematic use of clinical
observations as a means of guiding their research (Gold-
fried, 1982).
2
The third issue is our tendency to neglect past
contributions to the field (Goldfried, 2000). We do not build
on our previous body of knowledge but rather rediscover
what we already know or— even worse—ignore past work
and replace it with something new. What follows is a
description of how these three issues prevent psychotherapy
from achieving a consensus, after which there will be a
consideration of some possible steps that might be taken in
working toward a resolution of these issues.
What Are the Obstacles to Reaching a Consensus
About Psychotherapy?
Disagreement Across Theoretical Orientations
From early on, the field of psychotherapy has been char-
acterized by the proliferation of different schools of thought
1
It has been suggested by some workers in the field that psychological
treatments should replace the term psychotherapy. There have been reac-
tions against this, and it continues to be a point of contention. Because the
term psychotherapy is the term used by most professionals, it will be used
in this article as well.
2
It might be noted that the field of psychotherapy is not alone in this
regard; it has also been acknowledged to exist in medicine (DeLuca,
Ovseiko, & Buchan, 2016) and in education (Finnigan & Daly, 2014).
This article was published Online First September 17, 2018.
I thank Louis G. Castonguay, Joanne Davila, and Stephen O’Grady for
their helpful comments on an earlier version of this article.
Correspondence concerning this article should be addressed to Marvin
R. Goldfried, Department of Psychology, Stony Brook University, Psy-
chology B Building, Stony Brook, NY 11794-2500. E-mail: marvin
.goldfried@stonybrook.edu
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
American Psychologist
© 2018 American Psychological Association 2019, Vol. 74, No. 4, 484– 496
0003-066X/19/$12.00 http://dx.doi.org/10.1037/amp0000365
484
... To promote trust within the treatment alliance, GPM offers a coherent, predictable approach that identifies the reduction of BPD symptoms and promotion of functioning as the key purpose of the relationship. GPM also relies on common factors among different psychotherapeutic approaches (Goldfried, 1982(Goldfried, , 2019. Specifically, through psychoeducation, GPM instills hope and expectations that treatment can help the patient make life changes and increases recognition of modifiable factors related to the patient's problems. ...
... Corrective experiences, initially described by Alexander and French (1946) as an alternative to working through earlier unresolved conflicts through the traditional psychoanalytic process, refers most broadly to the process whereby patients act in news ways that may have been previously avoided due to fears and prior beliefs, as a means of disconfirming their unrealistic predictions of outcome. From these corrective experiences, more reliable reality testing is possible, enabling people to update previously held beliefs about themselves in relationship with others with learning from new experiences (Goldfried, 2019). The combination of corrective experiences-whether through changes in interpersonal functioning or exposure-based interventions-with enhanced reality testing empowers people with BPD to face life challenges with awareness of their inherent difficulties appreciating trustworthiness in and collaborating with others in ways that are increasingly adaptive and reliable. ...
Corrective Experiences to Enhance Trust: Clinical Wisdom From Good (Enough) Psychiatric Management
Article
Unstable trust within social interchange underlies the symptom constellation of borderline personality disorder (BPD), resulting in preoccupation with intense dyadic relationships, limited capacity for social collaboration, and constricted social networks. Good Psychiatric Management (GPM) provides a distilled formulation of how interpersonal hypersensitivities drive the engine of BPD's symptomatic oscillations in both affect and attachment. The authors summarize clinically relevant conclusions from the empirical literature on trust in BPD, synthesize it with selected ideas from other empirically supported interventions, and distill a formulation of how the GPM approach can address problems of trust in BPD with strategies most clinicians can use to improve their work with patients. GPM's clinical management approach utilizes common factors in psychotherapy to structure collaboration with patients to be accountable partners in treatment, rely on themselves more to diminish unrealistic demands on others, and function more effectively in arenas that expand and stabilize their social network.
View
... Therefore, it is possible to interpret rumination and cognitive fusion as two aspects of the same global construct: hyperreflexivity. This is also in alignment with the integrative approach in psychotherapy, which recognizes that much of the disagreements between different psychotherapy models stem from a linguistic issue: the use of different terms to describe the same phenomenon (Goldfried, 2019). Indeed, some intervention proposals aim to combine various techniques from different psychotherapeutic models into a single intervention (Barlow et al., 2017), but this requires clarifying which processes of change are involved, so that different terms are not used for the same process (Nuttgens, 2023). ...
... Indeed, some intervention proposals aim to combine various techniques from different psychotherapeutic models into a single intervention (Barlow et al., 2017), but this requires clarifying which processes of change are involved, so that different terms are not used for the same process (Nuttgens, 2023). There are several proposals to base psychotherapy research on processes or mechanisms of change, including both traditional (Goldfried, 2019) and more recent approaches (Hofmann, 2020;Hofmann & Hayes, 2019). ...
Experiential Avoidance and Hyperreflexivity as Variables Associated with Depression: A Process-Based Approach
Article
Full-text available
  • Aug 2023
La depresión es un problema importante de salud pública que afecta a una proporción significativa de adultos jóvenes, como los estudiantes universitarios. Para su estudio se ha propuesto un enfoque basado en procesos, que busca identificar variables psicológicas transdiagnósticas que puedan ser objeto de cambio en las intervenciones psicoterapéuticas. El propósito de este trabajo fue analizar la interrelación entre un conjunto de variables de proceso (fusión cognitiva, rumia y evitación experiencial), así como examinar la relación entre cada una de estas variables y la depresión en 368 estudiantes universitarios de entre 18 y 29 años (M = 21.35, DE = 2.36, 77.7 % mujeres). Se halló que la fusión cognitiva y la rumia conformaban una variable global denominada hiperreflexividad, mientras que la evitación experiencial constituía un constructo diferente. Al analizar un modelo de ecuaciones estructurales, se encontró que solo la hiperreflexividad predecía significativamente la depresión. Se discuten estos resultados y sus posibles implicaciones para la práctica clínica. Se recomienda seguir estudiando la hiperreflexividad como una variable supraordinada de relevancia para la psicopatología.
View
... Therefore, it is possible to interpret rumination and cognitive fusion as two aspects of the same global construct: hyperreflexivity. This is also in alignment with the integrative approach in psychotherapy, which recognizes that much of the disagreements between different psychotherapy models stem from a linguistic issue: the use of different terms to describe the same phenomenon (Goldfried, 2019). Indeed, some intervention proposals aim to combine various techniques from different psychotherapeutic models into a single intervention (Barlow et al., 2017), but this requires clarifying which processes of change are involved, so that different terms are not used for the same process (Nuttgens, 2023). ...
... Indeed, some intervention proposals aim to combine various techniques from different psychotherapeutic models into a single intervention (Barlow et al., 2017), but this requires clarifying which processes of change are involved, so that different terms are not used for the same process (Nuttgens, 2023). There are several proposals to base psychotherapy research on processes or mechanisms of change, including both traditional (Goldfried, 2019) and more recent approaches (Hofmann, 2020;Hofmann & Hayes, 2019). ...
Experiential Avoidance and Hyperreflexivity as Variables Associated with Depression: A Process-Based Approach
Article
Full-text available
  • Aug 2023
Depression is a major public health problem that affects a significant proportion of young adults, such as college students. A process-based approach has been proposed for its study, which seeks to identify transdiagnostic psychological variables that can be the target of change in psychotherapeutic interventions. The purpose of this paper was to analyze the interrelation between a set of process variables (cognitive fusion, rumination, and experiential avoidance), as well as to examine the relationship between each of these variables and depression in 368 college students aged 18–29 years (M = 21.35, SD = 2.36, 77.7% female). Cognitive fusion and rumination were found to comprise an overarching variable termed hyperreflexivity, while experiential avoidance constituted a different construct. By analyzing a structural equation model, it was found that only hyperreflexivity predicted depression significantly. These findings and their possible implications for clinical practice are discussed. Further study of hyperreflexivity as a superordinate variable of relevance to psychopathology is recommended.
View
... Over the past 40 years, we have witnessed various movements to challenge established (though not so strongly empirically supported) boundaries to diagnosis and intervention; that is, challenges to definitions established by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) taxonomies and by the major treatment traditions in individual psychotherapypsychoanalytic, behavioral, and humanistic (e.g., Castonguay et al., 2019;Dalgleish et al., 2020;Goldfried, 2019;Hayes & Hofmann, 2020;Wampold, 2015). These challenges represent efforts to break up these somewhat arbitrary boundaries and to integrate by carefully considering and building on the empirical evidence, particularly the evidence demonstrating the clinical conditions and change processes present for many conditions and across many psychotherapies (see Barkham, Lutz, & Castonguay, 2021; ...
How can we most effectively conceptualize and conduct psychotherapy according to evidence-based principles? A consideration of change processes, clinical choices, and positions
Chapter
  • Nov 2023
Over the past 40 years, we have witnessed various movements to challenge established (though not so strongly empirically supported) boundaries to diagnosis and intervention; that is, challenges to definitions established by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) taxonomies and by the major treatment traditions in individual psychotherapy—psychoanalytic, behavioral, and humanistic (e.g., Barlow & Farchione, 2017; Castonguay et al., 2019; Dalgleish et al., 2020; Goldfried, 2019; Hayes & Hofmann, 2020; Wampold, 2015). These challenges represent efforts to break up these somewhat arbitrary boundaries and to integrate by carefully considering and building on the empirical evidence, particularly the evidence demonstrating the clinical conditions and change processes present for many conditions and across many psychotherapies (see Barkham, Lutz, & Castonguay, 2021; Norcross & Lambert, 2019b). In this chapter, we (a) provide a review of these movements to define critical and common change processes in psychotherapy and (b) then turn to a careful consideration of the clinician’s role in many of these processes, specifically with regard to clinical decision making and the clinician’s positionality (i.e., their cognitive– affective states and behavioral actions). Given the growing body of evidence demonstrating the importance of therapists’ individual differences in explaining process and outcome in psychotherapy (see Castonguay & Hill, 2017; Wampold & Imel, 2015; see also Chapters 14–16, this volume), we would be remiss not to address this factor thoroughly in our discussion of change processes. In this regard, we run the gamut from clinical judgement, emotional involvement, and cultural complexities to technical principles and strategies that have also been empirically implicated in the success or failure of psychotherapy.
View
... Often cited is Alexander and French's description of the "corrective emotional experience" (Goldfried, 2019), in which an old pattern collides with a disconfirming experience. Similarly, exposure therapy requires activation of an old pattern along with words and experiences that disconfirm the sense of dangerousness. ...
Why Psychotherapy Trainees Need an Updated Framework
Preprint
Full-text available
  • Aug 2023
Where psychotherapy training is too complicated and splintered, knowledge of the science and requirements of memory reconsolidation both confirms and explains how diverse therapies achieve change. Having a unified, explanatory framework helps students organize knowledge from multiple sources to visualize and apply underlying principles to clinical work.
View
Toward a synthesis of cognitive behaviour therapy via component analysis of self‐regulation
Article
  • Oct 2023
The cognitive behavioural therapies (CBTs) are the choice psychotherapies for many clinicians treating a wide range of adult psychological disorders including various anxieties, mood, substance use, eating, schizophrenia and personality‐related. Empirical research in the CBTs is ever increasing, and the accumulating evidence supporting efficacious treatments is substantial and well documented. However, with prolific research comes a seemingly accelerating and worrying trend of purportedly different therapies, and numerous hybrids and combinations of therapies and techniques. For many clinicians this is increasingly confusing and not helpful in clinical practice. This article is a critique of current trends and directions in clinical research, which show signs of limited effectiveness, fragmentation, and obfuscation. An alternative strategy is proposed—examining transdiagnostic therapeutic effects, which appear related to treating pervasive dysregulated emotions, with component analyses of four principal self‐regulation components (viz., self‐monitoring; functional analysis; identifying values, goals and treatment‐plans; and feedback). Such a strategy is likely to lead to a more coherently synthesized and effective CBT.
View
The Power Threat Meaning Framework and Self-Discrepancy Theory: Complementary Perspectives Psychotherapy and Counselling Journal of Australia
Article
Full-text available
  • Sep 2023
The efficacy of psychotherapy is now well-established, and research has provided strong evidence for several change factors, such as the therapeutic relationship, insight, corrective experiences, and reality testing (Goldfried, 2019). Increased understanding of the therapeutic change process has been a notable advance in psychotherapy, but an agreed view of the nature and causality of psychological problems has eluded the psychotherapeutic professions. The dominant medical paradigm within psychiatry and psychology asserts a predominantly neurobiological basis for psychological problems while humanist and relational paradigms prefer a broader and meaning-oriented basis for understanding such problems. This paper provides a review of one alternative conceptual framework, the Power Threat Meaning Framework (PTMF) developed by the British Psychological Society. While the PTMF offers a comprehensive alternative method for conceptualising mental health, it does not provide a specific practice roadmap. The framework’s authors encourage therapists to apply the PTMF in conjunction with their own theoretical preferences. In this paper, I have two aims: the first, to outline and examine the principles inherent within the PTMF, and the second, to provide an example of how the PTMF might be operationalised using an existing theoretical model, self-discrepancy theory (SDT). While the principles of the PTMF can be integrated with a host of theories of psychotherapy, SDT is utilised here as an heuristic to demonstrate the utility of the PTMF.
View
Development and Preliminary Analysis of a Scale to Assess Client Characteristics that Influence Clinical Decision-Making
Article
Full-text available
  • Oct 2023
Understanding client variables relevant to clinical decision-making is a core feature of psychotherapy. The previous meta-analysis emphasized variables related to stages of psychotherapy, motivational stages of change, alliance, reactance, coping, attachment styles, and emotional stability in psychotherapy outcomes. However, a clinical measure that captures these empirically based clinical variances is missing. The present study describes the development and preliminary analysis of the Clinical Decision-Making Inventory (CDMI), in a sample of individuals engaged in a psychotherapeutic process. One hundred and twenty-three participants (M=20.28, SD=5.80), engaged in a psychotherapy process, were assessed in a cross-sectional design. On one hand, the stages of psychotherapy, motivational stages of change, reactance, coping, attachment styles, and emotional stability were negatively correlated with symptomatology, cognitive fusion, interpersonal problems, coping mechanisms, and expressive suppression. On the other hand, correlated positively with metacognition, and cognitive reappraisal. Attachment style and emotional stability predicted symptomatology. The Clinical Decision-Making Inventory showed promising results, however, more research is required to deepen the psychometric analysis.
View
Contending With Polarization in the Expanding Scope of Psychotherapy
Article
  • Sep 2023
The author queried 32 colleagues about their sense of polarization in the field of psychotherapy, using as an example the contrast between generalists (like himself) and specialists. This query was inspired by the proliferation of brands of psychotherapy coupled with the dominance of cognitive-behavioral therapies. His key conclusions: (a) tensions in the field are associated with a multitude of polarities and individual differences; (b) it is folly to reduce polarization to any single polarity; and (c) given the field’s huge diversity, we are all specialists. While the author advocates greater integration of theories and methods, he also argues for expansion by including ethical thought into the scientific zeitgeist. He proposes skill in being human as a broad aspiration for therapists and patients.
View
View
ResearchGate has not been able to resolve any references for this publication.