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Unread November 20th, 2006, 10:31 PM
James Pretzer James Pretzer is offline
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Join Date: Jun 2004
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Default A few comments

Just a few comments on the last several posts in this thread...

I can't really comment on Bruce Wampold's "The Great Psychotherapy Debate" and Scott Miller's "The Heroic Client" because I haven't read them. However, I am very sceptical about the conclusion that all therapies work equally well and that it doesn't matter what treatment approach we use for a given client as long as we have a good therapeutic alliance.

Does anyone really believe that all the different therapies that have been developed are equally valid? Should we revive Reich's Orgone Boxes? Manipulate undetectable "energy fields" to treat serious problems? Use past life regression as a treatment method? While these examples may seem extreme, remember the wide range of therapies that have their advocates. I've heard of at least one therapist in town who was using crystals and channeling and billing it to insurance companies as psychotherapy.

If we don't test therapies to find out what they accomplish, how are we to distinguish the valid therapeutic approaches from the absurd? It isn't that empirically-supported treatments are the only effective therapies or that they are necessarily the most effective therapies. It is that with some therapies we have reason to believe that they accomplish what their proponents claim they accomplish. With therapies that haven't been tested we have to decide whether to simply accept them on faith or not.

It would be great if all that was needed was a good therapeutic alliance but it isn't that simple. We have a good example right here. This thread is about CBT with BPD. Does Wampold seriously believe that all you need to treat BPD effectively is a good therapeutic alliance? If so, I wonder how many clients with BPD he has treated. For years, many therapists thought that BPD was untreatable. Now it is gradually becoming clear that some treatment approaches are ineffective, some actually make client's problems worse, and some at least are effective in decreasing symptomatology and improving functioning. While no one is claiming to have found a cure, there actually are a number of studies that suggest that CBT (and some other treatment approaches as well) can help people change to the point where they no longer qualify for a personality disorder diagnosis.
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