Psychotherapy is one of the most extensively researched treatments for mental disorders. When compared to no treatment or psychopharmacology, patient reports and comparative studies have demonstrated that psychotherapy is, in general, effective, efficient, and lasting (Asay & Lambert, 1999; Seligman, 1995). Researchers have also compared psychotherapy treatments hoping to find the most efficacious ones—a laudable undertaking.
However, this undertaking has resulted in disenchantment on the part of many practitioners who feel keenly the gulf between research and practice (Talley, Strupp, & Butler, 1994). It is a paradox that efforts to demonstrate the beneficial effects of psychotherapy have led researchers to develop models and methodologies that are far removed from psychotherapy processes and practices.
The relation between treatment research and real-world psychotherapy is not as dichotomized as the previous section implies. In the course of efficacy studies, researchers have identified efficacious therapists. Their findings prompt a revision of the research question away from which therapy is more efficacious to which therapist is. For example, researchers in the NIMH’s Treatment of Depression Collaborative Research Program (TDRCP) generated therapeutic efficacy scores for all TDRCP therapists and reanalyzed their data (Blatt, Sanislow, Zuroff, & Pilkonis. 1996).
The most efficacious therapists had patients improve significantly more, had less variability in patient outcomes, and had stronger alliances as perceived by patients. Alliance is considered a common factor across therapies. Efficacious therapists were not significantly different from less efficacious therapists on demographics or level of clinical experience.