Since the times of Freud, Jung, and Adler there has been ongoing debate about which theoretical orientation is superior. In fact, in some circles that debate still rages today. Well, the idea of superior therapies has slowly been whittled away by research. The good news is that since counseling outcome research began to boom in the mid-1970s we have learned, year after year, that counseling and psychotherapy is very effective and
consistently yields a large effect size (Smith & Glass, 1977; Miller, Hubble, Chow, & Seidel, 2013). However, the difference in effectiveness between one theory of counseling and another is typically not statistically significant when compared in controlled research. This notion was dubbed the Dodo Bird Verdict (Luborsky, Singer, & Luborsky, 1975). You may recall that in Alice in Wonderland that the Dodo Bird declared that “All have won and all deserve prizes”. This reference to the Dodo Bird in counseling dates all the way back to 1936 with a fellow by the name of Saul Rosenzweig who stated that different psychotherapy approaches achieve roughly equivalent outcomes (Rosenzweig, 1936). This finding has been replicated many times over in randomized controlled trials since then. For instance, outcome researchers Bruce Wampold and Zac Imel (2015) conducted a massive meta-analysis of over 300 studies and found that there was no significant difference in client outcomes across treatment approaches.
Putting Theories in Perspective
An additional factor from research that we know is important for a good outcome for clients seeking counseling is that their counselor believes in the theory they use. This is referred to as “allegiance effects” (Wampold & Imel, 2015). Why do I mention this? Well, it is important that you have a theory or theories that resonate for you and that you are competent to deliver counseling in accord with that theoretical orientation. However, it is also important to keep in mind “your theory” isn’t THE best but it may be the best FOR you as a counselor. As mentioned, argument over which theory is inherently the BEST is somewhat of a dead-end. However, when counselors believe that their theoretical approach can be helpful, they are competent in this theory, and they deliver it in a way that fits with the client’s preferences, positive counseling outcomes are enhanced (Miller et al., 2013). Counselors do need a theoretical framework to provide structure and foundation to their work. However, they also need to be able to modify, adjust, and tailor that approach to the client in front of them.
The Authentic Chameleon
We have moved into an era in which more clinicians identify as somewhat integrative as opposed to past eras of ideological purity (Norcross, Karpiak, & Lister, 2005). With this in mind, it makes sense to look to a forerunner in intergrative (or eclectic as he called it) approaches to counseling. Arnold Lazarus (2006) expressed many important points about integration and one is technical eclecticism. This simply refers to selecting techniques based on what clinical wisdom and research indicate are likely the best method, intervention, or style for the individual client. However, there is a very important consideration here. Lazarus warned that choosing from various treatment techniques in a capricious, temperamental manner or without sufficient training is what he referred to as syncretism (Lazarus, 2006). The latter is highly undesirable and potentially unethical. The bottom line is that it makes sense for clinicians to match their style and methods with that of the client, so long as they are trained and competent in the method and are engaged in supervision and professional consultation around the use of those methods.
In addition to intentionally and competently selecting different interventions, Lazarus (2006) also placed emphasis on the counselor adapting his or her style to the client. He termed this authentic chameleon. In essence, this refers to adapting one’s interpersonal style to fit the client and this may include domains such as the level of formality/informality, degree of personal disclosure, level of directiveness, and degree of supportiveness to name a few. On a personal note, I generally tend to be soft in my vocal tone and gentle in my demeanor as a counselor, however, working with tough Alaskan fishermen lead me to use a different interpersonal style in some cases. With a number of “tough” male clients (often who were mandated to treatment) I developed a stronger vocal tone and a firm, matter-of-fact demeanor. Thus, our style needs to be somewhat adaptable to the client in an authentic manner.
Over 40 year of research has demonstrated that there is little to no difference in counseling treatment outcomes when comparing one bona-fide treatment approach to another (Miller et al., 2013). However, two factors that contribute tremendously to the outcome in counseling are the client’s view of the therapeutic alliance and the counselor’s competence and belief in the theoretical model they use (Miller et al., 2013). Thus, counselors need to pursue training in theoretical models that resonate with them and learn how to adapt their style and the models they use to fit with client preferences and needs. One of other consistent finding is that there is significant variation in client outcomes across different counselors (Miller et al., 2013). In other words, some counselors have better client outcomes than others regardless of their theoretical orientation. Engaging in deliberate counseling practice, learning to use a theory (or integrate a few theories) competently, and engaging in ongoing evaluation of the alliance we have with clients is a way for counselors to improve their outcomes (Miller et al., 2013).
Lazarus, A. A. (2006). Brief but comprehensive psychotherapy: The multimodal way. New York, NY: Springer Publishing Co.
Luborsky, L., Singer, B., & Luborsky, L. (1975). Comparative studies of psychotherapies: Is it true that “everyone has won and all must have prizes”? Archives of General Psychiatry, 32(8), 995-1008. Retrieved from http://search.proquest.com/docview/616001416?accountid=14593
Miller, S. D., Hubble, M. A., Chow, D. L., & Seidel, J. A. (2013). The outcome of psychotherapy: Yesterday, today, and tomorrow. Psychotherapy, 50(1), 88-97. doi:http://dx.doi.org/10.1037/a0031097
Norcross, J. C., Karpiak, C. P., & Lister, K. M. (2005). What’s an integrationist? A study of self-identified integrative and (occasionally) eclectic psychologists. Journal of Clinical Psychology, 61(12), 1587-1594. doi:http://dx.doi.org/10.1002/jclp.20203
Rosenzweig, S. (1936). Some implicit common factors in diverse methods of psychotherapy. American Journal of Orthopsychiatry, 6(3), 412-415. Retrieved from http://search.proquest.com/docview/1470519089?accountid=14593
Smith, M. L., & Glass, G. V. (1977). Meta-analysis of psychotherapy outcome studies. American Psychologist, 32(9), 752-760. doi:http://dx.doi.org/10.1037/0003-066X.32.9.752
Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. (2nd ed.). New York, NY: Routledge.