Changing Frontiers in the Science of Psychotherapy

Irving Babbitt, Allen Bergin

• Publisher: Routledge
• Year: 2017
• Topic: Psychology
• eBook ISBN:
  9781351529471
• Subtopic: History & Theory in Psychology
• Index: Psychology

This book is an exploration and mapping of the frontiers of research in psychotherapy. The authors make a systematic effort to discover where the science is going; analyzing conceptual problems, trends, and issues; record their interviews with the leaders in the field; and recommend new directions for research. The volume is the result of a three-year study on collaborative research in psychotherapy by the National Institute of Mental Health, and was first published in 1972.In Changing Frontiers in the Science of Psychotherapy Allen E. Bergin and Hans H. Strupp introduce the reader to therapeutic science as it appeared to them during a three year process of evaluating available literature, conducting interviews with scientists and therapists, and exchanging and formulating viewpoints. Personal reflections and experiences were gleaned from working papers, correspondence, and personal material, all of which gave life to the ongoing processes of science and provide considerable insight into everyday reality behind the scenes.The prominent therapists interviewed in this book include Arnold A. Lazarus, Lester Luborsky, Arthur H. Auerbach, Lyle D. Schmidt, Stanley R. Strong, Paul E. Meehl, Howard F. Hunt, Bernard F. Riess, Thomas S. Szasz, Arnold P. Goldstein, Gerald C. Davison, Bernard Weitzman, J. B. Chassan, Kenneth M. Colby, Albert Bandura, Robert S. Wallerstein, Harold Sampson, Louis Breger, Howard Levene, Ralph R. Greenson, Milton Wexler, Carl B. Rogers, Charles B. Traux, Joseph D. Matarazzo, Neal E. Miller, Henry B. Linford, Peter H. Knapp, John M. Shlien, David Bakan, Marvin A. Smith, and Peter J. Lang, all of whom remain leading figures in the literature on psychotherapy.

ONE


Introduction

Three national conferences on research in psychotherapy, held in Washington, D.C. in 1957, Chapel Hill in 1961, and Chicago in 1966, pointed up the need for investigators to pool their resources and to consider the design of research projects which might be executed on a collaborative basis. Precedents for such ventures were of course available in biomedical research, but had been conspicuously absent in psychotherapy. Informal suggestions at the first two conferences evidently were not followed by any action; the situation, however, was different at the Chicago conference. For one thing, a small group of investigators was more articulate about the problem; for another, the Clinical Research Branch of the National Institute of Mental Health—all three conferences had been supported by grants from the National Institute of Mental Health—was taking an active interest in the possibilities of collaborative research in this area.¹

As a first step, John M. Shlien, the conference chairman, appointed an informal committee of conference participants to explore the feasibility of a collaborative study of psychotherapy. The following individuals were asked to explore the feasibility issue: Kenneth Mark Colby, Jerome D. Frank, Howard F. Hunt, Joseph D. Matarazzo (Chairman), John M. Shlien, and A. Hussain Tuma.

Although the committee was informal and did not have standing with any official group or organization, it consisted of researchers who believed that examination of the feasibility of coordinated or collaborative research was long overdue and that concerted action should be taken toward this end.

The committee met several times during the 18 months following the conference. At the initial meeting, it was concluded that an answer to the feasibility question required as a first step a critical review of the psychotherapy research literature. It seemed essential that a hard look at what the field had produced to date was necessary in order to determine whether studying other aspects of the feasibility issue would be fruitful.

We were asked by the committee to undertake this critical review of the literature and agreed to do so. We devoted the period from June through December 1967 to this undertaking, carried out under contracts from the National Institute of Mental Health. The results of our analysis were published as the February and March 1969 issues of the International Journal of Psychiatry (reprinted in this volume as Chapter 2 and Chapter 3). A bibliography of research in psychotherapy was completed as a by-product (Strupp & Bergin, 1969).

In our review, we reached the conclusion that the field might possibly be ready for one or more major collaborative studies, pending further feasibility testing and pilot work. Concomitantly, we outlined several studies which might prove fruitful.

We subsequently met with the originating committee in January 1968, by invitation of the Clinical Research Branch of the National Institute of Mental Health, and discussed future plans. Donald Kiesler, Nathaniel Raskin, and Charles Truax were also present. As a group, we discerned two possible next steps : (1) Independent investigators might pursue on their own one of the Strupp-Bergin recommendations for promising lines of inquiry; or (2) further investigation of the feasibility issue might be undertaken in greater depth. The latter would involve consideration of such problems as kinds of variables to be studied, by whom, under what conditions, and in which settings; research designs which might most profitably be explored; consultants who might be approached for help on such matters as research design, statistical analysis, and professional and practical issues in collaboration; whether independent investigators could be persuaded and motivated to participate in a coordinated or collaborative study; and whether such an undertaking would be economically feasible. Clearly, such an inquiry might also lead to the equally important conclusion that collaborative research, while perhaps desirable, is either premature or not feasible.

At this point, stimulated by our previous work and the undeniable importance of the problem as reflected by the interest of the originating committee and the National Institute of Mental Health, we decided to embark on an examination of the questions outlined above. Accordingly, we submitted an application for a research grant to the National Institute of Mental Health. This application received favorable consideration and we began work on the project in the fall of 1968.

The Feasibility Study

To answer the questions that we and the originating committee posed, we planned the following approach:

1. We would explore in depth the relative merit and priority of several major psychotherapy research questions and relevant experimental designs in consultation with experts on substantive and methodological issues, to scrutinize the designs which we had identified as promising (in our review),² and to determine the relative merits, power, feasibility, and potential contribution of the specific studies to the furtherance of knowledge in psychotherapy. This step would involve the possible combination, amalgamation, modification, and specification of projects in an effort to arrive at optimal designs. This phase of the planning would begin from the vantage point of a considerable body of past research and it would reflect the thinking of many investigators who have seriously concerned themselves with general problems of research strategy; we would assess the respective merits of individual and collective or coordinated efforts; we would examine problems of experimental design, choice of variables, and measurement; and we would review strategies of collaborative research in psychotherapy and other areas of comparable complexity. It was of course clear to us that we were dealing with a refractory area of research: administratively, studies have been extremely difficult to implement, and technically, variables have been hard to define, measure, control, or manipulate.

2. We would inventory resources available at various centers in the nation for undertaking major responsibility for collaborative work. We would not begin by organizing a large national network of collaborating centers nor elicit specific commitments from them; rather, we planned to test, through visits and interviews with key personnel at differing levels in each center, the depth of interest and motivation for undertaking coordinated research and to survey the clinical and research resources available. Through intensive work in conjunction with consultants and research centers, we would hope to arrive at progressive approximations representing a reasonable balance between such factors as precision of measurement, acequacy of controls, potential contribution to the advancement of basic knowledge, and investment of manpower, facilities, and financial resources.

3. In our meetings with consultants and our visits to clinical centers, we would keep a record of information and evaluations, which would eventually form the basis of a detailed report on the feasibility of specified collaborative research projects. We would give special attention to the following considerations : (a) several models or designs for collaboration may prove feasible, and they may or may not be like those implemented in other fields; (b) the planning should aim for ends which cannot be accomplished by individual investigators or agencies; (c) master plans may include core variables and standardized measurements but will not preclude measures preferred by or unique to any cooperating therapist or treatment center; (d) it is important to be cognizant of the potential value of a variety of therapeutic techniques, influences, and innovations which have not yet been studied extensively but which might profitably be included in future research; and (e) a central coordinating mechanism for collaboration will have to evolve from our efforts and report if one or more projects are actually implemented.

4. We planned to devote the first year primarily to the testing of feasibility, development of a research plan (or several alternate plans), including identification of potential participants, investigators, clinical settings, and patient populations. Should a collaborative study of major consequence appear not feasible, then the planning phase terminates and a final substantive report will be submitted. However, should the indications be positive, the planning moves into the second year. We would then devote more of our energies to actually working out specific details needed for mounting a study. This would involve obtaining specific commitments from potential collaborators and then deciding on a specific plan of study with appropriate design and specific measuring instruments, control variables, screening and selection procedures, procedures of selecting and training of raters, and the actual implementation of pilot work.

Consultants were carefully selected in terms of their known expertise and their potential contribution to the objectives outlined in the foregoing. Prior to our visits, we sent each person a copy of our review, the grant proposal, and a set of 18 questions which we had formulated as stimuli for discussion.³ Between October 1968 and July 1969 we spent from half a day to a full day with the following consultants : Arnold A. Lazarus, Lester Lu-borsky, Arthur H. Auerbach, Lyle D. Schmidt, Stanley R. Strong, Paul E. Meehl, Bernard F. Riess, Howard F. Hunt, Arnold P. Goldstein, Thomas S. Szasz, Gerald C. Davison, Bernard Weitzman, J. B. Chassan, Kenneth Mark Colby, Albert Bandura, Robert S. Wallerstein, Harold Sampson, Louis Bre-ger, Howard Levene, Ralph R. Greenson, Milton Wexler, Carl R. Rogers, Joseph D. Matarazzo, Charles B. Truax, Neal E. Miller, Henry B. Linford, Peter H. Knapp (with Martin A. Jacobs, Louis Vachon, and Douglas M. McNair), John M. Shlien, David Bakan, Jerome D. Frank, Peter J. Lang, and Marvin A. Smith.

Following each visit, we independently prepared critical resumes based on notes taken during the meeting. In addition to exchanging these documents, we prepared various working papers, met at regular intervals for the purpose of assessing the progress of our endeavor, read extensively (often following up on suggestions made by the consultants), and shared our impressions with selected colleagues.⁴

This book presents chronologically and in detail each phase of the work described in this introduction. We have attempted to provide for the reader a look into the workshop of therapeutic science as it appeared to us during three years of evaluating literature, interviewing scientists and therapists, and exchanging and formulating viewpoints. A number of critical reactions to our positions and viewpoints are included. We have also attempted to weave into the material our personal reflections and experiences and those of others whom we have interviewed. In Chapter 4, we have included working papers, correspondence, and personal material which gives life to the ongoing processes of science and, we think, provides much insight into the realities behind the scenes.

This scientific Odyssey begins in Chapters 2 and 3 with our review of the literature and the subsequent reactions of critics.

Reference

Strupp, H. H., & Bergin, A. E. 1969 Research in individual psychotherapy: A bibliography. Washington, D.C.: National Institute of Mental Health.

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Reproduced in part from the Journal of Abnormal Psychology, 1970, 76:13-26, by permission of the American Psychological Association.

This report is the last in a series of documents analyzing the current status of psychotherapy research, the promise of large-scale collaborative investigations, and possible future directions of the field. The work has been supported by the National Institute of Mental Health through contracts No. PH-43-67-1386, Hans H. Strupp, Principal Investigator, and No. PH-43-67-1459, Allen E. Bergin, Principal Investigator; and Grant No. MH16250, Hans H. Strupp, Principal Investigator, and Grant No. MH 16244, Allen E. Bergin, Principal Investigator. We are most grateful for this support and for the devoted interest and help provided in all phases of our work by Drs. A. Hussain Tuma of NIMH and Joseph D. Matarazzo of the University of Oregon Medical School. We are also grateful to Drs. Jerome D. Frank and John M. Shlien who served as advisors, and to the nearly three dozen consultants and colleagues who gave unreservedly of their talents in response to our requests. They have significantly stimulated our thought and enriched our lives.

1. Reflecting this programmatic interest, A. Hussain Tuma attended the conference as an official observer, and subsequently both he and Donald Oken, then Chief, Clinical Research Branch of the National Institute of Mental Health, worked with us closely throughout this effort.

2. These designs followed classical experimental models involving therapy, control, and other technique comparison groups along with rigorous selection procedures and preouteome and postoutcome measures. They were heavily influenced by the tradition of outcome experimentation associated with H. J. Eysenck, C. R. Rogers, R. I. Watson, M. Scriven, D. J. Kiesler, and others.

3. These questions are reproduced at the beginning of Chapter 4.

4. A full account of these interviews and related materials is presented in Chapter 4.

TWO


Some empirical and conceptual bases for coordinated research in psychotherapy

Research in psychotherapy¹ has failed to make a deep impact on practice and technique, presumably, because the results of most investigations have not had substantial practical significance. Reasons for this lack include the relatively short period of time systematic research has been focused on the problems of psychotherapy, déficiences in techniques available to the researcher, and practical difficulties in designing and carrying out adequately controlled studies.

Most researchers have been faced with serious limitations in collecting and analyzing data from representative samples of patients and therapists. Follow-up studies have been difficult to carry out; the crucial requirement of enlisting the full cooperation of therapists, patients, and institutions has been a continual stumbling block; and in general, rigorous designs have been difficult to impose upon the therapeutic phenomena themselves. Researchers who have attacked problems in the area through experimental analogues and similar techniques frequently have been unable to relate their findings to actual therapy situations.² These issues have been amply discussed by numerous writers (Bordin, 1965; Edwards & Cronbach, 1952; Ford & Urban, 1967; Frank, 1959; Glover, 1952; Goldstein, Heller, & Sechrest, 1966; Hunt, 1952; Kiesler, 1966; Sargent, 1960, 1961).

Two additional problems have limited the practical value of previous studies in psychotherapy, despite the fact that a number of them are of high scientific quality. One is the extreme complexity of the phenomena under study. Because of this factor, individual researchers have by necessity been forced to restrict their efforts to relatively narrow aspects of the larger problem. The other serious problem has been the lack of adequate communication and cooperation among researchers. Consequently, we are faced with a serious lack of comparability in conceptual tools, hypotheses, methods, procedures, subjects, measuring instruments, etc. (Sargent, 1961). To some extent this situation has been due to differences in theoretical viewpoints among researchers, basic convictions about the nature of psychotherapy, and similar factors, which in turn have led to very different and noncompar-able data. There has been a lack of agreement on specific aims and objectives of therapy research as well as criteria of outcome (Bergin, 1963). Furthermore, most researchers have been working in relative isolation, and they have had little opportunity to examine critically similarities and...

Table of contents

• Cover Page
• Title Page
• Copyright
• Contents
• Foreword
• 1. Introduction
• 2. Some empirical and conceptual bases for coordinated research in psychotherapy
• 3. Critiques, replies, and correspondence
• 4. Testing the feasibility of major collaborative efforts
• 5. New directions in psychotherapy research: A summary statement
• 6. Epilogue
• Index