TESCAPE
FROM
BABEL
Building a L/ntfling Language
for
Pradice
PsychotheraPy
No psychotherapyis superiorto any other' although all
. This is the concluston
are superiorto no treatment.
drawn by authoritative reviews
, and well-controlled
quite
remarkable,
rs
really
This
outcomestudies.. . .
given the claims of unique therapeutic properties made by
iduocates of the various treatments available today '
Joel Weinberg,1995,P. 45
No theory, just as no profession,can claim preeminence
for long if it cannot firmly establishthat its adherents
agreeon the useof its basicorganizingconcepts.
Stuart A. Kirk and Herb Kutchins, 1992' p. 31
basisof paralysisagitans-the shakHE PATHOLOGICAL
for more than
I i"g palsy-defied medicalunderstanding
a hundred years.lfith the greyingof the population,this
brain-basedcondition bearingthe name of the man who provided the best first description, Parkinson, has become all
too familiar to patients,their families,family physicians'psychiatrists,and neurologists.!7hat is lessappreciatedare the
singular, almost bizarre, psychologicalexplanationsoffered
by mental health professionalsfor the genesisof the disease'
From the earliest accounts.,observersnoticed that those
"emotional and attituafflicted with the diseasedisplayed an
dinal inflexibility, a lack of affect and a predispositionto
depressiveillness,which may antedatethe developmentof
motor abnormalities bv several decades"(Todes & Lees'
20
ESCAPE
FROM BABEL
1 9 8 5 ,p . 9 7 ) . I n 1 . 8 7 5t,h e f a m o u sF r e n c hn e u r o l o g i sCt h a r cot consideredthat emotions in combination with hereditary
factorswere instrumentalin bringing on the condition. Over
the years,the notion that a patient'saffectswere the culprits
in Parkinson's diseasehas kindled highly specuJativebut
nonethelessinfluential explanations.
To illustrate, in the late 1940s Booth hypothesizedthat
the pre-Parkinsonpatient lived in a tenuousbalancebetween
striving for independenceand freedom from aurhority whiie
conforming to socialexpectationsand standards.He further
believedthat thesepatientswere inculcatedfrom their childhood with the idea that they should abide by socialnorms at
the expenseof their feelings.According to Booth, this resultedin the developmentof a social mask to cover or screen
hosdle and sadisticimpulses.The diseaseemergedwhen the
equilibrium of a patient'spsychologicaleconomy-the social
mask-was upset through frustration, loss of independence,
or eruption of aggression.Although this descriptionfits zosr
people growing up and living in American sociery,nor jusr
patients with Parkinson'sdisease,Booth believed that the
factors he had identified were causallylinked ro rhe onset of
the disease(Booth, 1948).
Looking back, the purpose of this kind of wild character
analysiswas to establisha psychogenicor funcrional cause
(read: explanation) for Parkinson'sdisease.Using supposedly "hard" data, such as Rorschachresponses,clinical experience,and professionalobservation,to supporttheir hypotheses, professionalsconfidently promoted their etiological
hunches-mainly in the vocabulary of psychodynamics.
!7hat is troubling is that this edificeof psychologicalconjecture stood largely unchallengeduntil researchersestablished
that the depletion of the neurotransmitterdopamine in the
substantia nigra (part of the midbrain) accounredfor the
debiiitatingmotor disorder (Hubble & Koller, L995).
Sadly, the story of Parkinson'sdiseasehighlights a recur-
;
t
T--
Building a Unifying Language
2I
ring theme in the mental health professions.Intoxicated by
modelsand a penchantfor complex but mostly vacuouspsychological theories,clinicians often accord their beliefs the
statusof clinical reality. Throughout the history of the field,
virtually every school of therapy has forcefully championed
its own explanationof problem formation, treatment goals,
and unique methodsfor resolvingor mitigating clienrs'complaints. With an immodestyapproachingoutright hubris, the
proponentsof eachschoolhave insistedthat the explanations
and outcomes of their paradigm are fat superior to other
treatmentmodels. As clear as this pattern may be, however,
the field seemsdoomed ro repeatit. It is as though thereis no
end to the impulse to exaggeratethe explanarorypower and
therapeuticeffectiveness
of psychotherapymodels.
Consider,for instance,a recentarticlein The Family Therapy Networker (the magazine with more readersthan any
other professionalpublication in the field) on one of the
latesttrendsto sweepthe therapy model marketplace:narrative therapy. One writer claimed that the new approach not
only has "an immediate impact on troubled people'slives"
but, through "its ability to put ideology into action," could
also end racism, sexism, and any other political "ism" to
w h i c h i t w a s a p p l i e d( O ' H a n l o n , 1 9 9 5 , p . 2 4 ) . O r , h o w
about a nationally circulated ad for a rherapy called, "NLP
Eye Movement Integration." The ad asks the would-be consumer, "'V7ouldyou like to learn a method that is faster,
simpler, safer, and more effectiue?" \X/e11,what provider
wouldn't? In this era of managedcare, survival increasingly
dependson how well and how quickly clinicians can ger
results-a considerationnot lost on advertisers.Lastlv. how
about the latestbook by Albert Ellis ( 1,995),enritled'Better,
Deeper,and More Enduring Brief Tberapy, in which readers
are promisedto learn methods:
.
not only usefulwith lessseverely
disturbedclients,but
alsowith difficult clientssuchasthoseafflictedwith Dersonal-
22
ESCAPEFROM BABEL
ity disorders, psycbotic states, orgdnicitlt, and mental defic i e n c y . ( B r u n n e r / M a z e l B u l l e t i n, I 9 9 5 , p . 5 , e m p h a s i s
added)
Yet. when Ellis's claims are contrasted with available researchon the outcome of brief therapy, the rhetoric simply
does not add up to reality. In reviewing the brief therapy
literature for their chapter in the latest edition of the Handbook of Psychotherapyand BehauiorChange,Koss and Shiang(L994) found the following:
IThereis] compellingempiricalevidencethat brief psycho-
therapy is effectivewith specificpopulations.. . . brief therapy has been found to be /esseffectiuewith more seueredisorders, such as tbose of personality,substanceabuse, and
p s y c b o s i s(.p . 6 8 1 , e m p h a s i a
sdded)
What can the practicing clinician conclude regarding most
of the claims made by the developers of treatment models?
Given the very real difference between their rhetoric and empirical reality, it is safe to assumethat while creating a great
deal of heat they throw very little light on the subject at hand.
THE VOCABULARY OF
A UNIFYING LANGUAGE
(-_'
-,h
is the familiar at usually eludesus in life. What is bel r Jre
our noseis what we seelast.
f
William Barrett
\ilith almost forty years of researchfindings in hand, we
can sav witl confidencethat the various manifestationsof
_**.?r..-.?_*'_i.|''
7+-#
work not
ttlreiapvare moie7trEe6fr-&ff6ent. T'lterapies
"their
-*lte-c-au:sces dr speciali zed
bf
tini que'expIanatory sChCni
<
-i"+-.
t
'
.l
'
lang[aEe',on the=c_ontrary,
as was polnted out ln tne prevlous
-ctrapter;-ihEii su99_9_qs-_!q based on what they have
Laregty
;
I
l.
-!i
T-
Building a Unifying Language
ZJ
in common. In this regard, veteran psychotherapyoutcome
researcherMichael Lambert (1994, personal corrununication) has observed:
\Whenyou watch good therapybeing done, you know it and
it has a lot of commonalities. . . IG]ood cognitivetherapists
and good behaviortherapists,psychodynamictherapistsact
an awful lot alike.
It is the very commonalitiesnoted by Lambert that form
the basis of a unifying languagefor psychotherapypractice.
Fortunately, adopting such a language does not mean that
therapistsmust learn an entirely new or even different languageof psychotherapypractice.In fact, the words and conceptsof the unifying languagewill alreadybe familiar to most
clinicians,basedas they are on what all therapistsalreadydo
that contributesto successfulclinical work. For thoseweary
of keeping up with the endlessnumber of new treatment
models,the unifying languagewill certainlybe welcomed.
Therapists will also find that their clients are atruned to
the commonalities linking all good therapy. Indeed, most
speakthe languagewith easeand require no specialtraining.
In this regard, when researchersask clie4ts_4fuq1gbg_!slpful
io"
aspectsol tn.rr
lnterventions or techniques. Instead
sEEEifiEl-rnLoiieT-diiuen
identify the same variable_s
as th_erapeuticthey corisGTently
b_qqg_gnreqpgc,t.ed,
_o_f-'5ei.ng
@
dEisioodand being ggry{lo-tllf--ambert, personal communieetfrfl|'Ir{TfTfiis ;;-- body of researchshowsthat clients
also expecttheir therapistsnot to be bound to any one brand
or language of treatment. Consider, for example, a study
conductedby Kuehl, Newfield, and Joanning(1990), which
found that clients who viewed their therapist as not rigidly
adheringto a particular point of view were more likely to be
satisfiedwith their exDeriencein treatmenr.
FROM BABEL
ESCAPE
1 A
THE ELEMENTSOF
A UNIFYINGLANGUAGE
Four common curative elements'each central to all forms
of therapy despitetheoreticalorientation' mode (i'e', individual, [.oup, family, etc.), or dosage(frequencyand number of sessions),constitutethe unifying language'Thesefour
elements,in order of their relarivecontribution to changein
factorsl (2) therapyrelatherapy, are: (1) extratherapeutic
tionship factors; (3) model and techniquefactors; and (4)
expect;ncy, hope, and placebofactors (Lambert, 1'992)'
Extratherapeuticfactors: Clientsand
their enuironment
Everythingis luck and timing. Abilit,vcounts' but abilitf is
alrvaysthird.
D o n a l dL a m b e r t i ,1 9 9 5
In the clinical literature, clients have long been portrayed
"unactualized,"messagebearersof family dysfunction,
as the
and in most theraPeutictradimanufacturersof resistance.,
tions, targets for the presumably all-important technical interventio;. Indeed, it seemsthat once people decideto enter
treatment they suddenly become something less than they
were before. They ceaseknowing their o\ /n mind' are dis"something"
connected from their feelings, certainly have
wrong with them that requiresfixing, and, of course'will do
their Jevilishbestro resisrthe therapisr'seffortsto help them.
It is curious that the very profession that makes helping a
virtue has also made a cult out of client incompetence'A
testamentto the successof this cult of incompetenceis the
significantdegreeto which the pathology- and deficit-based
lu"ngu"g.of the recoverymovement and the Diagnostic and
.:
t
Buildinga UnifyingLanguage
25
StatisticalManual of Mental Disorders (APA, 1.994) have
been embraced by American popular culture (Kaminer,
1.992).
In the sameway that clients are assumedto be fragile or
ineffectivein someway, therapistsare consideredthe masters
and heroesof the therapeuricencounrer.There are hundreds
of books about great therapistsbut few, if any, books about
great clients.
Nowhere is this tendency more obvious than in professional workshops and conferenceswhere some woebegone
individual, couple,or family is recruitedfor a live demonstration conductedby some recognizedexpert in the field. Especially desirablefor theseproductions are those clientsthought
to be at an "impasse"with their current therapist.Before an
audienceof perhapshundredsof mental health professionals,
clients bare their dilemmas and ill fortune to the "master,"
who invokes reportedly innovative conceptsand techniques
to transform the clienr-at least that is what the audienceis
paying to see. Underscoringthe point, videotapesof these
demonstrationscan be rented or purchasedby practitioners
through a proprietary operation called, what else, The Master Therapisls(trademarkedby AAMFT).
As these examples illustrate, much of the writing and
thinking about psychotherapypracticeplacesthe therapistat
center stagein the drama known as Tberapy. Rarely is the
client cast in the role of the chief agent of change. Nevertheless,the researchliterature makes clear that the client is
actually the single, most potent contributor to outcome in
psychotherapy. The quality of clients parlicipatiqn, their
perceptionof the thbraprstan
L1!8'
dEte?min-C
wheiherany trearmentwi]-lwq1L-ln faq!,-the_total
matrix of who they are- their 9-qgqgthlg-{ff egq{g*e_sr_
lhe
durarion
the circurnstarrcesin which th
rs thar
FROM tsABEL
ESCAPE
26
*
weave in and out of their lives-matters more than anything
therapistsmight do4Clients, the researchmakes abundantly
ttey
cleat, are the true m@ycfoTfertt/;
a?defwals-m ore po Werful th an tlie ii iheiapi it s'.
*[n
,Fa.tsea]chlii&ature., t5e client's contribution to outcome is part of a categoryof common therapeuticelements
called"extratherapeuticfactors." Thesefactorsare estimated
to accountfor the major portion of improvementthat occurs
in any treatment,a whopping 40"/". They refer to any and all
aspecrsof the clientand his or her environmentrhat facilitate
recovery,regardlessof formal participation in therapy (Lambert, 1.992).As such, extratherapeuticfactorsare the cornerstoneof the unifying languagefor psychotherapypractlce'
All therapiesbenefit from the operation of extratherapeutic factors, whether or not they are a part of the formal
languageor technique.By making thesefactors a part of the
everydaylexicon of psychotherapypractice, therapistscan
enhance their contribution to psychotherapyoutcome' In
will be given
Chapter 3.,detailedinformation and suggestions
for both recognizingthesefactors and including them more
deliberatelyin the treatmentprocess.
The tberapy relationshiP:
Client and theraPisttogether
j--
believein just ordering peopleto do things. You
f-i aon'..
!_hru.,o
sort of grab an oar and rou'u'ith them.
H't,old Cencut
.
!
1
|
I
_ l
l :
gl 19u g n .wn rc n
T h e t h er apeu tic re I att on sh t p t s t_[e-.]]_egt-9p
-;;:;fitr;;;;i.
""lFtEt and
"d exnerienced.
While thev
thel
experjqp-ced...While
i-sEnailed
^"d
-.;-thii"piits
thethera-seg{:.E-.tEeJ3p-vEino-wlddgglle-t-Tqortanceof
al outcomes.
le-uill ?elationshi p in producing beneFici
h;y;.
d'fi...., *o.dt ,"d;";;;p;;;
Er=
27
Building a Unifying Language
Over the last forty years, the influenceof the therapeutic
relationshiphas been tracked acrossan array of treatments
(e.g., behavioral and cognitive, psychodynamic,experiential, eclectic, group, and pharmacotherapy fHenry et al.'
1.9941).In all theseapproaches,a correlationhas beenfound
between the therapeutic relationship and psychotherapy
6utcome..&eqeal*9rl9str31._!9l",t*,Tggll-eq-3-Q-%r"9.f
lh.
"rela-
variancein psJilofierapy outeomeis due to so-called
tionil rpT##'
: A"-k-;g-tl e- second in ir" pqiraqqe"-!""L*
1,992).In fact, the evidence
ffi(Llmbert,
iJso strong that veteran psychotherapy researcherHans
"the quality of the interpersonalcon'
Srrupprecentlywrote,
textis the sinequa non in all forms of psychotherapy"(1'995,
p . 7 0 ; e m p h a s i isn o r i g i n a l ) .
Studiesfurther show that the quality of the client'sparticipation in the therapeuticrelationship is the singlemost important determinantof outcome (Orlinsky, Grawe' & Parks,
1.994).Clients who are motivated, engaged,and join in the
work with the therapistbenefitthe most from the experience.
Of course,the qualiry of clients'participation in treatmentis
greatly affected by the bond or alliance they form with the
helping professional.In contrast to what one might expect'
the researchdoesnot show that the strengthof this therapeutic alliance or bond is a function of the length of time a
client has been in therapy (Horvath & Luborsky, 1'993)Therapistswho worry that managedcare-with its unrelenting emphasison cost-effectiveand time-sensitivetherapymay make having helpful therapeuticrelationshipsimpossible can rest a little easier.
H-9.:j3pgltant
qhcraperrto the formationo-f.3-g1o-,4g
rt. ;h;h;;;nisiic-psycho-,.
trc atlrance,the resea?cl--tl,o*tr
gers co; sia;;.a .t[ 19ot. .-o"-Jition{' of \F
iT-Ro
Th-er-a
p
r
a
sT-c
'
-eTe
df ectivrp sfchb-tfi pf =:neslhy-.. t pb.t, " "i e. ! gu eni t s
(ffiW:1'993).
The latest researchand
?e
ESCAPE
FROM BABEI-
thinking indicate that strong alliancesare formed when ciients perceivethe therapist as warm, trustworthy, nonjudgmental, and empathic. Therapists'evaluarionsof their successin providing this kind of therapeuticenvironmentfor the
client are not enough. The core conditions must actually be
felt by the client, and each client may experiencerhe core
t conditions differently (Bachelor, 1988). In this regard, a
1growing number of studieshas found that clients'ratings of
\the therapeuticalliance,rather than therapists'perceprions,
lare more highlycorrelatedwirh outcome(Horvath & Lubor!sky, 1993; Orlinksy er aI.,,1994). For this reason,rhe most
a1qlikelyts-dgysleqyl'gub9-!lr91api
st esl.,t*!_:lli"lces
tabhshesa therapeuricrelationship
-;a
rhat matchesthe client's
Aeffiiiio;
.-t;tt, ;;""i;anes;,;;d .espi-i(b.,.,.u.,,
Scfio*vEy,
& RnsF,
t99r-.As r,l'astrue of extratherapeuticfactors.,all therapiesbenefit from the operation of relationshipfactors, whether or nor
suchfactorsare an explicit part of a particular model'stheory
or technique.Adding relationshipfacrorsto rhe unifying languagefor psychorherapypracticebuilds on what most trearment professionalsalready know about successfulclinical
work and will enabletherapiststo further enhancethe contribution of theseimportant factorsto psychotherapyourcome.
Recognizingand empoweringrelationshipfactorsis the topic
of Chapter 4.
Therapeutic technique: Tbe doings of therapy
Techniquesare ritualizedmethodsof human relatedness
and communication. . . . Techniquesand the personal
meaningsthev invoke are alvvaysembeddedin iuman relanonsnlps.
Micbael Mahonel'
Another elementin the unifying languageencompasses
the
categoryof therapeutictechnique.All therapistsmake use of
@'
Building a Unifying Language
29
technicalprocedures.In any given session,for example,one
may seea therapistasking particular questions,listeningand
confronting, providing inreflecting,dispensingreassurance,
formation, offering specialexplanations(reframes,interprerations), making suggestions,self-disclosing,or assigning
tasksto be done both within and outsidethe therapy session.
There are also technicalconsiderationsinforming where the
therapistand client should sit, when the sessionshould begin
and end, who is seen, and even whether or not the client
shouldbe offered tissues.
The content of the talk or questionsis different depending
on rhe therapist'stheoretical orientation and technique. Indeed,as was illustratedin Chapter 1.,differencesin technique
and the languageused to describethosetechniquesare often
convenientmarkers for telling therapistsapart and engaging
in heatedprofessionaldebate.Whatever model is employed,
however, most therapeutic procedures have the common
quality of preparingclientsto take someaction to help themselves.Across all models, therapistsexpect their clients to
do somethingdifferent-to developnew understandings,feel
differentemotions,facefears,take risks, or alter old patterns
of behavior.
In spite of the field's interest and investmentin technical
contribution
factors, however, their actual percentage-wise
to outcomepalesin comparisonto extratherapeuticand relationship factors. In his widely cited review of psychotherapy
that the the-raoutcomeresearch,Lambert (1992) _estlmates
pist'smodelal4_ry_clr11qggc,at!,rr-b,ute--o-nlp15.%.-to+heoveralf rrnpacl-oFpsycEothe.apy.Though this finding may be
trouEfiilg*io'
a;hooli oadia;;-ty that havepridedthemselves
on their unique conceptualizationof therapeuticprocessor
innovationsin interventionmethods(e.g., primal screaming,
genograms,miracle questions,EMDR, letter writing, etc.),
the data are clear: clientsare largely ulggp3g!_sj4_yth{_:lt
-
t n e r a p l s t s t e c h n l q u e s .A s L a m b e r t p u t l t :
30
ESCAPE
FRoM BABEL
fP]atients don't appreciate these techniques and rhey don't
regard these techniquesas necessary.They hardly ever mention, ever, a specific technical intervention the therapist
made. I'd encouragetherapiststo realizetheir phenomenological world about the experienceof therapy is quite different
than their patients'. The nontechnicll aspec-ts4!e the ones
mention.Also-,*E?n o6fectivel"!flesiistento tapes
-of-tn.rlpy.
.patients
the nontechnical
aspecrs
are the onesrhar corre'late
wlih outbmE morbtF?nanyrechnical
(perintervenrion.
sonalcommunication,
December
9, 1993)
When the practiceof psychotherapyis guided by a unifying language,therapeutictechniquesrops being a reflection
of a particular theoreticaldoctrine or school of therapy and
instead becomesthe vehicle for enhancingthe effectsof the
other common factors. The immediate result is that thera-
pistsspe.nd
l_e-s_:
d-nu;rr+pg6ffir@ntion
",tp..:-.-qe t!& th e;:ight b14g$*o*f:.!er ap y and spend"m or eit i me
doing what rheydo best:undersianZlng.
listening,building
-.41
"fi
f elati o-n"iliipa;;ia ?na ouih-ging i brii s t o nd :w ay $"t o heIp
' _i'
--*_-"-----*
themselves.
*.-.F--'"
Expectancy,hope, and placebo:
Tbe unsung triad
Contributing the same percentage-wise
amounr ro outcome as therapeutictechniqueare the final words in the vocabulary of the unifying language-expecrancy,hope, and
placebo (Lambert, 1.992).These facors are responsiblefor
that portion of improvemenr that clients experiencesimply
by making their way ro therapy. Researchshowsthat merely
expectingtherapyto help goesa long way toward counteracting demoralization, mobilizing hope, and advancing im-
provement ( Frank k Fr anI;rJ99FL----.-.--__"-'
St: ". Aelq-.+prgrff
c_qg_a
tion of such h"p-"ltr:!tglg! y
influencedby the therapisr'sartitudetowaid the clGnt ciuritig
Building a UniJyingLanguage
31
y. Pessimisticattitudes conto the client by an emphasison psychopathologyor the
l.e.v?a
difficult, long-term nature of change are likely to minimize
or curtail the effect of these factors.3lt the same time, an
emphasison possibilitiesand a belief thait*[email protected]
*ifiii[A-v *"{F t"EstilI hopi i"a i positi'ee"p!!f"iionfo.
th""fa be ,toted,however,tha-ttibatingthis
i--pi"u.-."t.li
-hopefnfihEipeutic
is not the sameas adoptinga
atmosphere
"everv
cloudhasa silver1ining,"attitudetoward
pollyannish,
resultsfrom ackno*l-/tu
Rather.hopefulness
clientdifficulties.
h the . ri.'Ft" niE'.''t-i'-rr[ 411;;i4., !t''..y;si' UitIedging b_o=t
\.
I
I
I
:
,
)
)
-7"--'-'i'.
tles tor a DeTtertuture.
*ThE
expectancy
r#aich-literature
showsthat hope and--.--.r
___r
. a.=...-._-...-*.-
ta?
l n _ m a n ya r e a so t l l f e - t n
give peoplea @e
s- - - . - " :
.rr
I
I
t'
| .
a c a d e m r ca c h l e v e m e n t .m a n a g t n g m a j o r l l l n e s s , a n o o e a l l n g
wiTh-aiffiAltjob situations(Goleman,7991,
). In the psychostudGsfurther showthat fosteringa positheiapy-Trterature,
tive expectationfor changemay actually be a prerequisitefor
treatment(Snyderet al., 1'991';Snyder,Irving, &
successful
Anderson, 199I). In Chapter 5, detailed information and
suggestionswill be given for making thesefactors an active
part of the treatmentprocess.
CONCLUSION
To generationsof therapistsrearedon the proposition that
ingenious and intellectually stimulating treatment models
and their associatedtechniquesmake the real differencein
therapy, the four common factorsthat really count may seem
pallid and anticlimactic. Therapists have been subjectedto
the most intenseforms of marketing. Books, continuing education seminars, and graduate school training most often
portray the processof producing change as a complicated,
technical.and often dramatic business.Facedwith the ardors
ESCAPE
FROM BABEL
of day-to-day clinical work, many therapistsmay feel that
the four factorsof the unifying languageare simply roo inert,
offering little help in addressingthe complex problemsmodern clientsbring to the consultingroom.
The fact of the matter is, however, that while therapists'
formulation of problems and experienceof the therapeutic
process may be complex, the factors that contribute to
successfulpsychotherapyarc not. The data indicatethat successfulpsychotherapywould be best understood as a rarher
simple, straightforward, and oftentimesboring business,distinguishablefrom other helpful experiencesin life only by the
explicit, sociallysanctionedcontract to be helpful that exists
between a therapist and client. No doubt, the practice of
psychotherapyis not always as easy one. Easy and simple
are, however, two very different matters. Clinical work may
frequently be trying, but that does not mean rhat the factors
contributing to successful
psychotherapyare necessarilycomplicated.
The best u'ay for therapiststo begin speakinga more unifying languageis for them to set asidetheir chosenmodel or
theory and look for and identify the four common factors
currently operating in their own clinical work. For instance,
becauseresearchhas establishedthat the quality of a client's
participation in treatment is the singlebest predictor of psychotherapyoutcome, cliniciansmight begin by closelyexamining what they alreadydo in order to engagethe client in the
therapeuticprocess.Given the magnitudeof the contribution
made by extratherapeuticfactors, therapistswould also do
well to look at what they presently do to utilize clients'
strengthsand resourcesin the achievementof trearment objectives.Additionally, therapistscan examine what they do
to engenderhope and a positive expecration for change in
their clients.
Before readingthe suggestionsand recommendationscontained in the following chapters, therapistsmight look for
Building a UntfYingLanguage
JJ
constievidenceof the operation of the common factors that
operatingin their clinical
trt. th. unifying languagecurrently
'Wizard
of Oz, therapistshave
work. Like Dorothy in Tbe
always had the means to get back to Kansas' No guru or
mastertherapist, no complex theory of human behavior or
.,advancedworkshop" is necessary.Neither is allegianceto
any one model or combination of models, methods, or doctrines. In effectivetherapy the common factors operate regardlessof the model or technique being employed' True,
ih. l"rrgrr"gemay lack the technicalprecisionor theoretical
elegancethat makessome existingtreatmentmodelsso comp.il"l.rg.Yet it has the advantageof forty years of empirical
iuppo.,. More important' perhaps, it has the potential to
uruiy clinicians from disparate traditions in their common
interestto help those in need of treatment.