Eclectic Psychotherapy Research Paper

1. The Growth Of The Psychotherapies And The Popularity Of Eclecticism

Although the field of psychotherapy grew at a distinctly slow pace during the first half of the twentieth century, the situation in the second half was decidedly different. Influenced greatly by the large number of psychiatric casualties in World War II, a tremendous increase in both the number of psychotherapists and in the number of different approaches or schools of psychotherapy has occurred. One can even view this surprising phenomenon as a growth industry, not only in the United States, but in many other countries as well. From the more than 60 different orientations or approaches to psychotherapy that I noted in the mid-1960s, the number has grown to over 400 at present (Garfield 1994). What has been particularly interesting (or amazing) has been the theoretical differences among these forms of psychotherapy, some of which appear to be diametrically opposed to each other, and the strong identification that the adherents of these approaches have to their chosen form of psychotherapy.

Despite this proliferation of the psychotherapies, another movement in psychotherapy, eclecticism, was growing rapidly, and in fact became the most popular approach to psychotherapy, particularly among psychologists. In the period from 1960 to 1990, a number of studies were conducted. ‘Depending upon the type and size of the subject sample as well as the survey methods and procedures used, the percentage of those who designated themselves as eclectics has ranged from around one-third to well over one-half of the samples evaluated, and eclecticism has always ranked as the number one choice’ (Garfield 1994, p. 124). In a recent report on primary theoretical orientations of clinical psychologists over the past three decades, it was also noted that eclecticism ‘remained the modal orientation’ (Norcross et al. 1997). It is also worth noting that an eclectic approach to psychotherapy has been popular with a wide variety of practitioners including clinical psychologists, counseling psychologists, psychiatrists, social workers, and marriage and family therapists.

2. Diversity Among Eclectic Therapists

Although one can state with some degree of assurance that an eclectic approach to psychotherapy is popular among most groups of psychotherapists, this knowledge will not inform a potential patient what procedures a specific eclectic therapist prefers and will actually use. There is a wide diversity among eclectic psychotherapists in how they conduct their therapy. In a study of 154 self-identified eclectic clinical psychologists, such diversity was clearly apparent (Garfield and Kurtz 1977). Each of the eclectic therapists was asked to select the two theoretical orientations that were most characteristic of the therapist’s eclectic approach and the two that were least characteristic. Interestingly, whereas 46 of the eclectic therapists indicated that they held a positive view of a psychoanalytic orientation, 41 expressed a negative view. Somewhat similar divergences were apparent with regard to other theoretical views. For example, 36 therapists expressed a positive view of Rogerian or client-centered theories as compared with 25 who gave negative responses. There were also some significantly divergent reactions to some theoretical orientations. Whereas 72 respondents held positive views of learning theory, 26 expressed negative views. In contrast, only 18 respondents indicated a positive response to rational–emotive therapy as compared with 57 who indicated a negative view. Existentialist views were also relatively unpopular with only 17 positive selections and 44 negative indications.

The respondents in this study were also asked to indicate the two theoretical orientations that they combined and considered most characteristic of their actual eclectic approach to therapy. Their responses again reflected the variability of views expressed by this sample of eclectic clinical psychologists. The most frequent combination, psychoanalytic and learning theory, was indicated by only 21 of the 154 respondents. The next two most frequent combinations were neo-Freudian and learning theory with 16, and neoFreudian and Rogerian with 9. Altogether, there were 32 different combinations of theoretical views indicated for the total sample. As is apparent, the eclectic orientation in psychotherapy covers a wide variety of viewpoints and procedures.

Eclectics thus are similar in not limiting themselves to just one theoretical orientation, but in their practice they exhibit considerable diversity. The emphasis is on selecting the procedures or techniques that appear to best meet the particular needs of the individual patient, or as some have phrased it: ‘Different strokes for different folks’—adjust to the individual patient instead of requiring the patient to adjust to the therapist’s strict adherence to one theoretical approach.

The diversity among eclectic therapists was also apparent in later studies and publications. In the Handbook of Eclectic Psychotherapy and the Casebook of Eclectic Psychotherapy edited by John Norcross (1986, 1987), several categories of eclecticism were discussed and illustrated. These included ‘functional eclectic psychotherapy,’ ‘systematic eclectic psychotherapy,’ ‘Multimodal Therapy,’ ‘radical eclecticism,’ ‘systematic technical eclecticism,’ ‘theoretically consistent eclecticism,’ ‘a transtheoretical approach to eclecticism,’ ‘a structural–phenomonological eclectic psychotherapy,’ and my own approach which is now referred to as a ‘common factors approach.’ As is apparent from the preceding list, diversity and proliferation appear to be characteristic features of the field of psychotherapy at the present stage of development. However, to provide the reader with a more concrete example of eclecticism in psychotherapy, I will make a brief presentation of one eclectic approach to psychotherapy which emphasizes the importance of both common and specific variables in the therapeutic process (Garfield 1995).

3. Therapeutic Variables: Common And Specific

Since the 1970s there has been a significant increase in the quantity and quality of research on psychotherapy. Although not all forms of psychotherapy have been systematically evaluated, the findings have generally been positive for those that have been so evaluated. Furthermore, with some exceptions, the comparative studies of these psychotherapies have reported few differences in outcome between them. For example, in one well-conducted study that compared psychoanalytic psychotherapy with behavior therapy—two very different forms of psychotherapy—no significant differences in outcome were secured (Sloane et al. 1975). Both forms of therapy had positive outcomes and their results exceeded those of a wait-list control group. Furthermore, taped sessions of the two therapies clearly reflected the differences in procedures of these therapies so that they could be identified easily. Nevertheless, the results of both were positive and not statistically different. In light of such findings, the possibility of common therapeutic factors among most forms of psychotherapy being responsible for at least a significant portion of the positive change obtained has emerged as a reasonable hypothesis. At the same time, for understandable reasons, the common factors hypothesis has not been warmly embraced by psycho-therapists who adhere strictly to one theoretical approach. It would appear that at least a number of therapists prefer to be identified with a specific form of therapy than to acknowledge that most therapies probably have a number of features in common, and that these common factors may account for a significant portion of the positive changes they produce.

4. Some Obvious Common Therapeutic Variables

A number of basic similarities among the different forms of psychotherapy can be noted. Even on a surface or superficial level, the following commonalities can be noted:

(a) Each form of psychotherapy requires a client or patient who seeks help for some psychological problem or problems.

(b) Each form of psychotherapy requires a therapist or counselor who supposedly has received or completed a program of appropriate training and has learned certain therapeutic skills.

(c) Some type of verbal interaction takes place between the participants.

(d) Usually some type of interpersonal relationship is also formed.

(e) Most patients also will have some expectations about psychotherapy and the role of the therapist.

(f ) A significant percentage of patients, regardless of the type of therapy secured, will drop out of therapy before the therapist indicates it is completed.

(g) A significant number of patients, usually around two thirds, will experience some positive change in their perceptions, cognitions, affects, and behavior.

Although many psychotherapists would agree with this list of possible common aspects of psychotherapy, they most likely would also state that these aspects or factors are not the really important factors that make for change in psychotherapy. The therapists would refer to variables or procedures that are emphasized in their particular approach. Interpretation and transference would be emphasized by psychoanalysts, reflection of feelings by client-centered therapists, and desensitization by behavior therapists. However, the theoretical processes mentioned can also be viewed or designated differently. What is important in psychotherapy is not what a particular therapist says has been done and expressed in the terminology of a particular system, but what was actually experienced by the patient. ‘The therapist’s perception of events is merely one view of what has occurred and may not necessarily be the best view’ (Garfield 1991, p. 9). Potential therapeutic variables that are not emphasized by a particular orientation will generally not be perceived by practitioners of that orientation. However, if the therapist assumes a more flexible attitude, a number of commonalities can be noted among the psychotherapies.

5. Important Common Therapeutic Variables

The most obvious important common variable is the therapeutic relationship that develops in psychotherapy, and it is important for both continuation and outcome in psychotherapy. Even behavior therapists who previously said relatively little about it have now acknowledged its importance. For example, Paul Emmelkamp, a distinguished Dutch behavior therapist has stated: ‘It is, however, becoming increasingly clear that the quality of the therapeutic relationship may be influential in determining success or failure of behavioral therapies, although well-controlled studies … are rare’ (Emmelkamp 1986, p. 432).

Although the therapeutic relationship is a common and necessary therapeutic variable, it is not sufficient alone to account for significant positive change in most cases. Other variables are usually required. For example, one variable that is emphasized by psychoanalytically oriented therapists is termed ‘interpretation,’ and is offered to provide ‘insight’ to the patient about the patient’s underlying problems. However, one can offer nonanalytic interpretations to patients. I have referred to such a process as providing explanations or understanding and others have referred to the same process as providing the patient with a therapeutic rationale. The point emphasized here is that there is no one ‘true insight’ or understanding or explanation. Each form of therapy provides its own and usually different explanations or interpretations—and, if they make sense to the patient and are accepted by the patient, they will usually have some positive impact. In other words, this is a common therapeutic variable among diverse forms of psychotherapy.

Additional therapeutic variables that may be common to most forms of psychotherapy are the creation of hope for being helped and the restoration of morale, the opportunity to confide one’s difficulties to a sympathetic and sanctioned healer, being helped to confront one’s problems, encouraged to try out new behaviors, being given helpful information, and even receiving advice and suggestions. These are all potential common factors that may not be mentioned in the official descriptions of the various forms of psychotherapy, but they do play a therapeutic role in psychotherapy. Reports of both observers of well-known therapists and patients attest to their use and importance. For example, in the Temple University Study (Sloane et al. 1975) referred to earlier, that compared psychoanalytic and behavior therapy, the patients in both groups tended to emphasize the same features of therapy in their appraisals at the end of therapy.

The successful patients in both therapies placed primary importance on more or less the same items. The following items were each termed ‘extremely important’ or ‘very important’ by at least 70 percent of successful patients in both groups:

(a) The personality of your doctor,

(b) His helping you to understand your problem,

(c) Encouraging you gradually to practice facing the things that bother you,

(d) Being able to talk to an understanding person,

(e) Helping you to understand yourself. (Sloane et al. 1975, p. 206).

6. Specific Factors In Psychotherapy

In the preceding discussion of common factors or variables in psychotherapy, an attempt was made to abstract processes that have been emphasized within different systems of therapy with variable terminology or that have been neglected in the descriptions of some therapeutic orientations. These have been viewed as basic common variables in psychotherapy. At the same time, there are some specific procedures or techniques that have been developed largely by behavioral or cognitive-behavioral therapists for treating specific clinical problems. These include relaxation procedures, homework assignments, exposure treatment, systematic desensitization, and cognitive restructuring. Whereas common factors can be viewed as basic therapeutic variables of importance in practically all therapeutic endeavors, specific factors of the type mentioned would be selected for use with specific problems or disorders. The choices made would be influenced by the available empirical research. The eclectic therapist thus has a wide choice of procedures, rationales, and techniques that can be used as indicated for the individual case.

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