Reassessing Psychotherapy Research.

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Russell, Robert L., Ed. Reassessing Psychotherapy Research. New York: Guilford Press, 1994. xiii, + 224 pp. $30.00.Early in this century, psychoanalytic process and outcome were reported exclusively as narrative, qualitative case studies. Treatment could be understood and evaluated only by understanding the analysand's idiosyncratic mental contents. By midcentury, however, theory-bound narrative explanations were less acceptable, particularly in light of disheartening charges (e.g., by Eysenck) that the efficacy of psychotherapy was wholly unproven. As a result, psychotherapy researchers gradually moved away from idiographic methods. They embraced a “drug metaphor” that attributed the efficacy of therapy to its active ingredient(s). The proper dosages of these ingredients would be uncovered through rigorous experiments. A fierce empiricism took hold, as various aspects of therapy were operationalized, differentiated, and categorized. In controlled experiments, therapists performed interventions on cue, and trained clinical raters produced “objective” data for quantitative statistical analysis. Psychotherapy research enjoyed a firm scientific footing and the means to uncover generalizable truths. Or so it was thought.Russell's ambitious volume includes contributions by several prominent psychotherapy researchers. They reassess past research, most notably their own, principally stressing the drawbacks of controlled, experimental, quantitative methods. While their messages differ somewhat, the overall thrust is that these tools are simplistic and inadequate for studying the complex, multidimensional, meaning-based phenomena of therapy. In their reconsidered view, discovery-oriented, hypothesis-generating research is preferable to hypothesistesting; qualitative methods surpass quantitative; pluralism trumps illusory objectivity. The postmodernist flavor of several chapters, particularly Russell's own, underscores the crucial role of context and the absence of a privileged observational perspective.All of the chapters are strong, interesting statements. The first, by David A. Shapiro and colleagues, presents a sweeping (and sobering) meta-analysis of psychotherapy research. In the second, William B. Stiles, Shapiro, and Heather Harper argue that “drug metaphor” assumptions obscure the relation of therapy process to outcome. They present an alterative “assimilation model,” illustrated with therapy excerpts. The third chapter, by Robert Elliott and Cheryl Anderson, presents complexity as friend, not foe, and offers suggestions for incorporating helpful amounts of it into research designs. Leslie S. Greenberg discusses psychotherapeutic change and discovery-oriented research strategies in the fourth chapter. In Chapter 5, Clara E. Hill reviews her progression from experimental analogue research to a more exploratory naturalistic approach. Russell forcefully critiques empiricism in chapter 6: “we must each articulate as best as possible our particular frames of reference and systems of description, and must volunteer to serve as one another's severest critics” (p. 181). In the last chapter, David E. Orlinsky and Russell offer a succinct historical review of psychotherapy research.As with most edited volumes, the vision is not quite unified. The notion of “active ingredients” in therapy, critiqued in the first two chapters, is adopted by Greenberg in the fourth. Some authors are vague about the kind of therapy they study: just psychodynamic, or other types as well? The domain of this work should surely be made explicit. Perhaps most fundamental, Russell seems more extreme than the others in his rejection of empiricism. In a footnote to their co-authored chapter, Orlinsky distinguishes his own view as “postpositivist empiricism embracing appropriate combinations of qualitative and quantitative methodologies” (p. 206). Most of the others would likely concur.Can psychotherapy research avoid empiricism? Should it? Russell notes that even advocates of postmodernist research resort to empirical methods. He calls this a bad habit, an unwitting lapse. Another possibility is that purely qualitative, postmodernist psychotherapy research may be impossible, or may not address questions we wish to ask.

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