The Viability and Utility of Consensus
We want to know what you think about seeking consensus in psychotherapy.
Posted May 06, 2020
I am relatively new to the field of psychotherapy, just finishing my doctoral program in clinical psychology in the coming months. I have been steeped in both psychodynamic and behavioral approaches to psychotherapy with a range of clients and presenting concerns. If the past six years of learning and practicing have taught me anything, it’s that there seem to be common themes that cut across all of psychopathology and how it is changed in psychotherapy.
However, I have yet to see a common explanatory framework that undergirds these theories and gives rise to a deeper understanding of the theoretical foundations of and the various access points focused on by different treatment approaches. I believe such a framework would provide a much-needed connection between rich and nuanced theory and burgeoning basic research on the human mind and brain.
A primary question that our SIG aims to answer is not only what are the basic psychological processes that underlie change, but also do these basic mechanisms underlie all of psychotherapy? A friend and professor researching psychotherapy process once pointed out to me that simply because a psychodynamic treatment and a cognitive treatment may both produce similar change with a similar patient does not mean that what happens in the mind to foster that change must be identical. Others have expressed reservations about coming to consensus, which may stifle an understanding of the complexity of the human psyche and its context.
I believe these points are not mutually exclusive with identifying, as Marv Goldfried writes, a “core of knowledge,” and as Jeffery Smith has described, a “kernel of universal change.” A small set of basic mechanisms, rooted in the discoveries of basic science over many decades, that occur as therapy helps the mind to better adapt exist at a different, deeper level than mediators of change, common factors, therapeutic principles, or specific interventions (Kazdin, 2007). In this way, changing cognitions in cognitive therapy and facilitating identity consolidation in psychodynamic therapy may rely on different interventions and different principles of change, yet they may both operate in the same way at the same basic level, such as to produce new learning (e.g., new or strengthened synaptic connectivity) and extinction of fear (being activated in the safety of the therapeutic alliance) that are the core of behavior change.
I believe rather than limiting complexity and nuance, such a core framework would actually facilitate research and therapy across treatment models while simultaneously bolstering integration, as the field of psychotherapy would finally share an explicit and common understanding of what happens at the most basic level during the therapeutic endeavor. Like how an understanding of the cell has facilitated biological research on both the similarity and the heterogeneity of life, an understanding of the core of change in psychotherapy is a vital paradigm from which we may each explore new territory and speak of it using the same language as our colleagues. Consensus can only come from conversation—and critique. What are your thoughts on the value of consensus on the core mechanisms of change across psychotherapy?
— Benjamin N. Johnson, MS
Kazdin, A. E. (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3(1), 1–27. https://doi.org/10.1146/annurev.clinpsy.3.022806.091432