Comparative Psychotherapy

An Experimental Analysis

Adolph O. Di Loreto

• Publisher: Routledge
• Year: 2017
• eBook ISBN: 9781351527286
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book details the first comparative study under controlled conditions of the three major schools of psychotherapy-client-centered therapy, behavioral or systematic desensitization therapy, and rational-emotive therapy. The study was organized to compare the effectiveness of these distinct forms of counseling with two distinct personality types-introverts and extroverts-in the treatment of two specific homogeneous problems-interpersonal anxiety and general anxiety. The study was reviewed by experts representing each of the schools of thought, and critiques are included as part of the total book.

Each school of therapy was evaluated to determine which was most effective with what type of subject. In this study, client-centered therapy proved to have the best results in reducing anxiety with extroverts, while the rational-emotive approach worked best with introverts. The therapy that had the greatest breadth, in terms of effectiveness for both kinds of clients, was systematic desensitization. This remarkable study should have far-reaching influence in the practical use of psychotherapy, and is essential reading for all professionals and psychology students who plan to enter the area of counseling. Instructors can use this book as a basic text or as a supplement to all introductory courses in clinical or counseling psychology offered at the senior/graduate level.

·1·
Introduction

Interest in the investigation of counseling and psychotherapy has both a history and evolution. It is unfortunate, however, that this common and long-standing concern in the constructive change of behavior and personality has fractionated rather than unified the interested parties. As Rogers (1963) has pointed out,

our differences as therapists do not lie simply in attaching different labels to the same phenomenon. The difference runs deeper. An experience which is seen by one therapist as healing, growth-promoting, helpful, is seen by another as none of these things. And the experience which to the second therapist is seen as possessing these qualities is not so perceived by the first. We differ at the most basic level of our personal experience.

Some people may feel that though we differ regarding specific incidents, . . . nevertheless in our goals and in our general directions there is much agreement and unity. I think not. To me it seems that therapists are equally divergent in these realms [p. 7].

One can best grasp the reasons for this current state of affairs by a more intense look at the evolution of psychotherapy research.

• Historical Perspective

The era prior to the experimental investigation of psychotherapy can best be characterized as “academic tribalism.” The various schools of psychotherapy which existed consisted of more or less loosely organized theoretical formulations based on biased and unsystematic observations which could not be controlled and thus repeated in any reliable manner. Consequently, adherence to any of these theoretical views was based on faith, conviction, and personal satisfaction; and loyalties were maintained and perpetuated by identification with a particular set of esoteric rituals (Bandura & Walters, 1963). Blocker (1967) seems to have captured the essence of this evolutionary process when he states:

Much of the history of change in counseling and psychotherapeutic theory and practice contains elements which closely parallel those which tend to dominate the evolution of religious movements and political ideologies. In both cases a movement tends to be originated by a messianic figure, characterized by a kind of élan vital, who translates a deeply moving personal experience into universalistic terms. This leader quickly attracts a group of worshipful disciples who immediately begin to generalize the precepts promulgated by the master into the most widely applicable terms, [p. 4]

With little more than faith and the sheer force of opinion to back their untested propositions and doctrinaire assertions, it is not surprising that these so-called coteries or “schools” existed as factions, often diametrically opposed to one another in terms of their aims, methods, and goals (Arbuckle, 1967; Bandura & Walters, 1963; Rogers, 1963). However, they exhibited such a faith and hope in the efficacy of their respective techniques that failures in practice engendered only a minimum of what Festinger (1957) has termed “cognitive dissonance.”

Both Phillips (1956) and Blocher (1967) have shown how a number of convenient expressions arose to buttress and thus justify the already well developed and deeply held personal convictions of these “schools” : for example, “the client is unmotivated,” “he lacks ego-strength,” “he doesn’t have enough working-anxiety,” etc. “The convenience of this type of thinking . . . for counselors who readily lose a third to a half of their clients prematurely, is, of course, obvious” (Blocher 1967, p. 14).

The net effect of these newly-coined rationalizations was to effectively screen out any negative feedback by automatically attributing untoward consequences to defects in the client (Ellis, 1962). When coupled with the enormous resistance to extinction generated by relatively few “successes” delivered on an aperiodic schedule, these factors served only to reduce any dissonance which may have resulted from failures in practice and thus eliminate any reason for change or modification in techniques.

Finally, dissonance between “schools” was further avoided by limited contacts between members of the dissonant factions. Even when they did interact, the violent polemics which resulted often generated more heat than light. According to Hoskisson (1965): “they ... get together and wrangle and defame each other and have a wonderful time, . . . much of specialized scientific publication seems to consist in mutual condemnation of each other’s work” (p. 29).

With the introduction of scientific methods into this formerly sacrosanct domain, it was hoped that a common core of empirical knowledge would replace the theories based on tenacity, faith, and intuition (Campbell & Stanley, 1963). This laudable but peremptory wave of optimism soon envanesced, however, when the predicted rapprochement somehow never really materialized.

Current status of the problem

In a summary of the overall impact of the past 25 years of research in counseling and psychotherapy, Shlien (1966) has pointed out that, “Continued subscription [to an existing school of psychotherapy] is based upon personal conviction, investment, and observation rather than upon general evidence” (p. 125). In a similar vein, Eysenck’s (1952)¹ first review of the outcome literature concluded with, “The figures fail to support the hypothesis that [existing forms of] psychotherapy facilitates recovery from neurotic disorders” (p. 323). His more recent reviews (Eysenck, 1955, 1960, 1961, 1965), as well as those of others (Baily, 1956; Bandura, 1964; Levitt, 1957), have led to essentially the same conclusions.²

The factors contributing to this current state of skepticism regarding psychotherapy are many and varied. As seen earlier, for a number of years this predicament was due to a lack of empirical research. However, as a number of authors have pointed out, the more recent causes stem from the fact that the existing empirical evidence is derived from such poorly organized and controlled research that the findings could be used to support almost anything, and thus, nothing (Blocher, 1967; Edwards & Cronbach, 1952; Kiesler, 1966; Paul, 1967; Sprinthall, 1967). In spite of this, researchers and practitioners alike have not tried to maintain a respectful tentativeness commensurate with their real ignorance of the problem. Rather, there is a tendency among partisans of each of the various positions to apply one standard of adequacy to inherently poor research when that research supports their theoretical position and an entirely different standard to the same type research when it is contrary to their position (Hunt, 1956).

As Goldstein et al. (1966) have pointed out, it is not uncommon for clinically minded researchers to disqualify and reject unfavorable results by pointing to methodological and control problems and then to cite at the same time favorably identical studies which support the position they advocate. More specifically, Bandura & Walters (1963) have shown how psychoanalysts frequently reject on the basis of inadequate translation negative findings when the research is based on a translation of psychoanalytic theory into learning terms. Yet the same psychoanalysts embrace positive findings with such enthusiasm that the purely psychic dividends which result unite to compel and further seduce their continued belief and increased entrenchment in psychoanalytic theory. What is the result? The era of “academic tribalism” still remains.

Schools of psychotherapy still exist with little more reliable, empirical foundations than before (Breger & McGaugh, 1965; London, 1964; Rogers, 1963). New schools continue to emerge here and there (Berne, 1961; Ellis, 1962; Eysenck, 1959, 1960,1965; Salter, 1961; Stamphl, 1967; Wolpe, 1958) again as factions radically opposed to the traditional ways of psychotherapy. Freshly minted ideas and glimmerings of understanding become so quickly encapsulated into the dogma of a “school” or coterie that they are seldom subjected to the scrutiny and “natural selection” of experimentation (Blocher, 1967; Breger & McGaugh, 1965; Dittmann, 1966). In fact, every effort is often made to protect and guard what each deems desirable, should it be “mistakenly confused” with the facts of research, for “nonconfirmation of a cherished hypothesis is acutely painful” (Campbell & Stanley, 1963, p. 3). ‘

Similarly, as before, these new schools maintain their autonomy and thus avoid any potential cognitive dissonance simply by building new jargons, creating new journals in which to publish their esoteric jargons (Behavior Research and Therapy, Voices, etc.), and generally divorcing themselves from the rest of the field. Successes by one school are either impugned as palliative, attributed to factors the critic’s school deems relevant, or blatantly disreputed (Rogers, 1963; Strupp, 1962; Wolpe, 1963; Wolpe & Lazarus, 1966). Finally, as earlier,. “Extremists on . . . [all] sides have not hesitated [in their expenditure of polemic words and ink] to discredit each other, even though well-controlled comparative studies are nonexistent” (Paul, 1966, p. 1).

Although collapse into a shapeless solipsism and feckless relativism, which are the death of science, is not eminent or pressing, this joint-catharsis-against-a-common-foe makes for little more than personal harmony and satisfaction within each faction; it contributes little in the way of constructive, cumulative knowledge (Campbell & Stanley, 1963). It is true that these precociously inspired theories often replace one another from time to time; however, since this displacement is typically not the result of well controlled, comparative research, the product rarely augments existing knowledge or serves as a sequel to what has gone before (Blocher, 1967). In short, it adds to the history of psychotherapy but not to its evolution.

The overall effect of this condition is forceably demonstrated in Colby’s (1964) analysis of the current predicament in psychotherapy—”Chaos prevails” (p. 347). Similarly, Rogers’s (1963) statement graphically portrays the net results of this current state of affairs—”The field of psychotherapy is a mess” (p. 8). Goldstein et al. (1966) feel that a “skein of confusion . . . represents our current level of understanding of the field of psychotherapy” (p. 10). Finally, London (1964) has conceded that “a detailed examination of the surfeit of schools and theories, of practices and practitioners that compete with each other conceptually and economically, shows vagaries which, taken all at once, make unclear what it is that psychotherapists do, or to whom, or why” (p. v).

Summary and prospective

As indicated above, a good portion of the confusion regarding psychotherapy is due to the fact that most existing schools of psychotherapy are based as much, if not more, on faith and dogma as on comparatively derived research findings. By worshiping their flimsy hypotheses into truths and then selecting “research” to bolster their already well developed personal convictions, these schools become implacable and categorically indestructable, that is, immune to dissonant empirical findings (Matarazzo, 1965). Evolution, if it can be called that, takes the form of “a fadish discard of old wisdom in favor of inferior novelties” (Campbell & Stanley, 1963, p. 2).

The foregoing analysis, although admittedly one-sided, is not intended to belie the importance of the immense problems and complexities which impede research in psychotherapy or allow, at best, for the most tenuous of controls

(Rubinstein & Parloff, 1959; Shlien, 1968; Strupp & Luborski, 1962). Indeed, much of the defection from experimentation to essay writing may be based on this very fact. As intimated above, a substantial portion of these difficulties can be attributed to very real and formidable methodological and control problems (Frank, 1959; Paul, 1967) and to the lack of a universal model for research in counseling and psychotherapy (Kiesler, 1966; Paul, 1966).

• Nature of the Problem

If counseling and psychotherapy are ever to mature beyond the level of “an undefined technique applied to unspecified problems with an unpredictable outcome” (Raimy, 1950, p. 93), then experimenters must abandon research models which perpetuate distinctions between existing schools and adopt those models which seek to define their techniques, circumscribe their limits of applicability, and demonstrate their efficacy in these delimited contexts (Gendlin, 1967; Gilbert, 1952; Kiesler, 1966; Sanford, 1953). In spite of the formidable obstacles created by methodological and control problems, and in the face of admonitions to the contrary (Hyman&Berger, 1965; Kiesler, 1966;Strupp, 1962), anum-ber of investigators feel that there is an adequate paradigm for research in counseling and psychotherapy which follows the foregoing prescription (Blocher, 1967; Edwards & Cronbach, 1952; Frank, 1959; Paul, 1967; Sprinthall, 1967). Such a design would consider simultaneously the following: input variables; process variables; outcome variables; follow-up variables. Let us consider each of these areas separately.

Input variables

Input variables concern the ingredients that go into or make up the treatment process, that is, client variables and therapist variables. The former deals with the client’s presenting problem or distressing behavior as well as with the more stable personal-social characteristics that constitute his life style. The physical-social environment or the client’s life space completes this triad. Therapist variables incorporate primarily the techniques the therapist uses in treatment and the more stable personal-social characteristics that constitute his life style or personality.

CLIENT VARIABLES. In terms of research methodology, client variables can be reduced to the dual problem of sample selection and treatment focus. Borrowing his strategy from research on the effects of drugs, Frank (1959) has suggested a most promising approach to this problem. It involves the selection and description of clients in terms of what he calls “target behaviors.” In other words, clients who are going to be used as Ss for research are selected on the basis of common or similar distressing behaviors. The description or operational definition of this common presenting problem then becomes the dependent variable in the research design. Furthermore, with this approach the goal of treatment then becomes behavior change in a specified direction. The efficacy of this approach has been successfully demonstrated by Paul (1966) in his attempts to reduce interpersonal-performance anxiety in college freshmen.

According to Paul (1966), therapy research should “compare specific techniques in the treatment of an emotional problem that is delimited enough to allow rigorous experimental methodology, but significant enough to allow generalization from the findings and to have implications for further study in the broader field of counseling and psychotherapy” (p. 9). It is my belief that interpersonal anxiety is just such a problem.

Anxiety, generally, is a central explanatory concept in almost all contemporary theories of personality and is regarded as a principal causative agent for such diverse behavioral consequences as insomnia, immoral and sinful acts, instances of creative self-expression, debilitating psychological and psychosomatic symptoms, and idiosyncratic mannerisms of endless variety (Spielberger, 1966). It has been observed to have untoward consequences on motor behavior and coordination (Luria, 1932; Malmo, 1966), cognitive effectiveness (Saltz & Di Loreto, 1965; Spielberger, 1966), and physiological functioning (Grinker, 1966; Malmo & Shagass, 1949). Even more important, anxiety reduction is a cogent aspect of most, if not all, existing theories of psychopathology and is seen by most practitioners as a salient therapeutic goal.

Interpersonal anxiety, or anxiety that results from simple, routine interactions with other individuals, is particularly debilitating since it can disrupt normal, but required, daily routines, make otherwise healthy individuals unhappy and dissatisfied with themselves, and generally create discomforts that are unfortunate and otherwise avoidable. Consequently, the area of anxiety generally, and interpersonal anxiety in particular, seems fertile ground for research from both a theoretical and practical point of view.

In terms of a target focus for research, small interacting treatment groups provide a prototype stress situation for eliciting interpersonal anxiety, and thus they can be used as an objective criteria for assessing by means of behavioral ratings change in this target behavior from pre- to post-treatment. The importance of this type of criteria has been exhorted by Strupp (1962) : “if psychotherapy is effective, the benefits must be somehow demonstrable in the person’s behavior” (p. 457). In addition, since interpersonal anxiety undoubtedly restricts interpersonal activity, a periodic sample of interpersonal contacts can also serve as an external criteria for assessing both progress during the course of treatment, and outcome. The importance of using behavioral criteria external to the treatment setting has been noted by a number of researchers (Luborsky & Strupp, 1962; Paul, 1967; Zax & Klein, 1960).

If one views the most important test of the effectiveness of a particular therapeutic treatment as involving first a change in the client’s distressing behaviors and second a change in these behaviors outside of the treatment setting, then these two criteria, in conjunction with client self-reports, go a long way toward achieving these goals.

Even with selection on a homogeneous class of target behaviors, however, there is likely to be wide variation in the relatively stable personal-social characteristics of the client (Paul, 1967). However, if in addition to matching target behaviors, clients are further selected, described, and classified on the basis of these relatively stable life style characteristics, pre-treatment variability among clients can be reduced further. The importance of this type of research for purposes of assessing treatment effects unambiguously has been noted by many investigators (Blocher, 1967; Kiesler, 1966; Levinson, 1962; Paul, 1967; Sprinthall, 1967; Underwood, 1957). However, research of this nature is conspicuous by its absence.

Personality type, although an admittedly illusive and somewhat arbitrary choice in terms of the available empirical evidence on personal-social characteristics, looms as a salient prognostic construct in the minds of many experienced researchers and clinicians (Blocher, 1967; Gelder & Wolff, 1967; Kiesler, 1966; Lang et al., 1965; Lazarus, 1963; Sargent, 1961; Sprinthall, 1967). As Luborsky (1962) has noted, “Of all the influences which are thought to determine the change a patient can make through treatment, the patient’s personality is most often thought to be predominant” (p. 123).

There are at least two reasons for this belief. First and foremost is the very real fact that the founders of nearly all existing forms of psychotherapy derived their theoretical formulations and based their techniques on observations of radically different types of clients (Kiesler, ...

Table of contents

• Cover Page
• Half Title Page
• Title Page
• Copyright
• Dedication
• Preface
• Acknowledgments
• 1. Introduction
• 2. Method
• 3. Analysis of results
• 4. Discussion of results
• 5. Summary and conclusions
• References
• Critiques
• A critique by Albert Ellis
• A critique by Alan Goldstein and Joseph Wolpe
• A critique by Angelo V. Boy
• Appendixes
• Index