The culture wars in psychotherapy dramatically pit the treatment method against the therapy relationship. Do treatments cure disorders or do relationships heal people? Which is the most accurate vision for researching, teaching, and practicing psychotherapy? Like most dichotomies, this one is misleading and unproductive on multiple counts. For starters, the patient's contribution to psychotherapy outcome is vastly greater than that of either the particular treatment method or the therapy relationship (Lambert, 1992; Wampold, 2001). The empirical evidence should keep us mindful and a bit humble about our collective tendency toward therapist-centricity (Bohart & Tallman, 1999). For another, decades of psychotherapy research consistently attest that the patient, the therapist, their relationship, the treatment method, and the context all contribute to treatment success (and failure). We should be looking at all of these determinants and their optimal combinations (Norcross, Beutler, & Levant, 2006).
Second, psychotherapy is at root a human relationship. Even when "delivered" via distance or on a computer, psychotherapy is an irreducibly human encounter. Both parties bring themselves--their origins, culture, personalities, psychopathology, expectations, biases, defenses, and strengths--to the human relationship. Some will judge that relationship a precondition of change and others a process of change, but all agree that it is a relational enterprise. Third, how we create and cultivate that powerful human relationship can be guided by the fruits of research. As Carl Rogers (1980) compellingly demonstrated, there is no inherent tension between a relational approach and a scientific one. Science can, and should, inform us about what works in psychotherapy, be it a treatment method, an assessment measure, a patient behavior, or, yes, a therapy relationship.
The common factors approach basically states that all therapies work because of what they all have in common, rather than what differentiates them from one another.
Metanalyses (e.g. Smith, Glass & Miller, 1980; Wampold, et al., 1997; Luborsky et al., 2002) tend to corroborate Rozenzweig’s (1936) verdict that everybody has won and must have prizes, a line taken from the Dodo-bird in Lewis Caroll’s Alice’s Adventures in Wonderland. Thatvery dissimilar interventions have similar effects diminished the seeming importance of specifictechniques.
What FAP (Kohlenberg & Tsai, 1987; 1991) proposes as the active ingredient of treatment slips through one’s fingers at every attempt to grasp it in a topographical description. It can best be conceptualized in terms of the functional relations between client behavior in session and the therapist’s responding to it, as each behavior occurs. These relations are complex, highly idiosyncratic for each case, and at times hard to predict. There are no specific and unspecific factors, but functional relations between events as they occur in the therapy room, and these derive their meaning from the broader context of the client’s life.
Research on treatment techniques as well as research on relationship variables may still hold great promises. But the needs of a nomothetic approach may be a hindrance to research on process. It may be that studying the fine tissue of therapy calls for a thoroughly ideographic and inductive strategy. In this case, the contribution that FAP may be able to make to therapy research lays in the development of this third current of research that, clearly differentiated from the two others, focuses the functional dimension of what happens in the therapy room.