The new issue of *Journal of Consulting & Clinical Psychology* (Vol. 76,
No. 6) includes an article: “Psychotherapy for Depression in Adults: A
Meta-Analysis of Comparative Outcome Studies.”

The authors are Pim Cuijpers, Annemieke van Straten, Gerhard Andersson,
& Patricia van Oppen.

Here’s how the article opens: “Whether all psychotherapies are equally
efficacious for the same disorder has been studied and debated for more
than 3 decades (Cuijpers, 1998; Luborsky, 1995; Luborsky, Singer, &
Luborsky, 1975; Shadish & Sweeney, 1991; Stiles, Shapiro, & Elliott,
1986), and no definite answer has yet been found in empirical research.
Early meta-analyses indicated that different types of psychotherapy were
equally efficacious (Smith & Glass, 1977; Smith, Glass & Miller, 1980).
One possible explanation for this finding is that most effects of
psychological treatments are caused by common, nonspecific factors and
not by particular techniques (Cuijpers, 1998). These common factors
include the therapeutic alliance between therapist and client, belief in
the treatment, and a clear rationale explaining why the client has
developed the problems (Lambert, 2004; Spielmans, Pasek & McFall, 2007).
Another possible explanation is that the effects of psychotherapy are
realized by various therapy-specific mechanisms (Butler & Strupp, 1986)
and that the number of possible mediators and moderators is so large
that small differences between treatments in specific groups of patients
remain unnoticed owing to insufficient statistical power or because
research methods are not sensitive enough (Kazdin, 1998).”

Here’s the abstract: “Although the subject has been debated and examined
for more than 3 decades, it is still not clear whether all
psychotherapies are equally efficacious. The authors conducted 7 meta-
analyses (with a total of 53 studies) in which 7 major types of
psychological treatment for mild to moderate adult depression (cognitive-
behavior therapy, nondirective supportive treatment, behavioral
activation treatment, psychodynamic treatment, problem-solving therapy,
interpersonal psychotherapy, and social skills training) were directly
compared with other psychological treatments. Each major type of
treatment had been examined in at least 5 randomized comparative trials.
There was no indication that 1 of the treatments was more or less
efficacious, with the exception of interpersonal psychotherapy (which
was somewhat more efficacious; d = 0.20) and nondirective supportive
treatment (which was somewhat less efficacious than the other
treatments; d = 0.13). The drop-out rate was significantly higher in
cognitive-behavior therapy than in the other therapies, whereas it was
significantly lower in problem-solving therapy. This study suggests that
there are no large differences in efficacy between the major
psychotherapies for mild to moderate depression.”

Here’s how the article ends: “Despite the limitations of our study, it
seems safe to conclude that there are few significant differences in
efficacy between most major types of treatments of mild to moderate
depression, including cognitive-behavior therapy. Interpersonal
psychotherapy may be somewhat more efficacious and nondirective
supportive therapy somewhat less efficacious. They all should have
prizes, but not all should have the same prize.”

The author note states that correspondence concerning this article
should be addressed to Pim Cuijpers, Department of Clinical Psychology,
VU University Amsterdam, Van der Boechorststraat 1, 1081 BT Amsterdam,
the Netherlands
Email: <P . C u i j p e r s @ p s y . v u . n l>.

——

Comment:

One of the important implications of this study has to do with cognitive-behavioural therapy (CBT), which is given special mention in this study.  Many agencies and institutions ask that psychologists provide ‘evidence based’ methods; that is, methods that are shown to be effective. Often, in my practice, this has meant that I am asked to provide CBT. My impression is that that CBT has been a highly researched form of therapy, which means that that there is evidence for it. My clinical experience has been that other approaches can also be effective, and this study bears this out.

I commented to a colleague the other day that perhaps it’s most important that we as therapists use an approach that we feel comfortable with – which allows us to really use the method and, crucially, to be who we really are in the therapist’s chair.  We know that the relationship in therapy is the biggest predictor of its outcome, and I for one cannot create a strong and positive relationship when I am being inauthentic, not myself. Over the last several years, I have been learning more and more to “show up” more fully, and for me this has meant using methods that fit my temperament and interests as well as the needs of the client. Sometimes that looks like CBT, sometimes not.

Learning psychotherapy, like learning how to be in relationship, is such an art. One that I am still learning after all these years and will probably continue to learn my whole professional life.

Brian Grady, Ph.D.

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