I think there is a difference between improving and saying we've arrived. There is still so much we don't understand about the mind and people in general that we can't really say we have the best ideas. I think that as long as patient satisfaction is increasing and improving that is what you can hope for. But you can never stop trying to improve care.

Diane Cole described “scientifically rigorous” ways to study psychotherapy without “randomly controlled clinical trials” (RCT). However, systematically controlling variables of interest and randomizing the effects of uncontrolled variables remains the “gold standard” for scientifically assessing psychotherapy. This methodology does not favor some approaches over others. Wampold’s critique of “the medical model of psychotherapy” that emphasizes “ the right treatment for any given DSM disorder” fails to recognize other possible uses for RCT.

Psychotherapeutic processes “can be defined in terms of speech, motor movements, physiological response indicators, and the relationship between behavior and the environmental context” (Sonnanburg, Psychotherapy, Vol. 33, No. 2, 1996). Any therapeutic exchange can therefore be tested with RCT. While that article addressed “outcome research,” my analysis applies equally to “process” variables. Measures of emotions, cognitions, social functioning, and standards of performance can encompass evidence from Wampold’s “contextual model” of psychotherapy, from cataloguing “common elements” subsumed by the therapeutic relationship, or from isolating “active ingredients” amidst specific interventions.

RCT identifies “best practices” for therapists to emulate. Experimentally controlling therapeutic variables does not limit therapist autonomy. Rather, therapists are freed to respond to a client’s emergent needs with reliably effective therapies.

If Da Vinci knew no chemistry of pigments, or if Michelangelo had not studied autopsied cadavers, their masterpieces would be diminished. I hope Pinsof is wrong about “most therapists” believing they cannot integrate scientific findings into their work without compromising effectiveness. I’m glad Cole ultimately foresees blended roles for both art and science in psychotherapy.

Keith Sonnanburg, Ph.D.
Seattle, WA

As was said in the 1970's, "Right On". The politics of this field, especially the monetarily driven ones, are tilted towards the medical model, replete with "techniques" for "types" of problems in living, which have, of course, been medicalized into "diagnosable disorders".
Here in the Chicago area the smug closed hydraulics of psychoanalysis seems to dominate the thinking of social workers in particular, who can neatly (and so authoritatitvely) diagnose and simultaneously demean a person (client)..."I'm so smart and you're so blechhhhhh!"
Makes me nuts!