First I would like to point out that "general consensus" should not be contrued to mean "true" or "accurate." General consensus held that the earth was flat and that schizophrenia was caused by refrigerator mothers. Obviously, neither one of these turned out to be true. But if your curious because you want to be within "the stardard of practice," then that is understandable. The word "proven" is also strange here. And "ineffective?" Well, whats the defintion of that term anyway. No improvement next to placebo (ie., a no tx condition. which is rare in this literature by the way)?
Less effective compared to another orientation perhaps (which is much more common to see), or maybe
statistically significant, but not
clinically significant?
However, back to the question. In general, the literature demonstrates that the differences in outcome between all the mainstream approaches is rather small. But keep in mind that some of these giant meta-analysises by people like Larry Buetler utilize massive Ns, and individual cases where the orientation was a huge piece of the outcome variance tend to get "washed out" in these massive studies. So, although one orientation might be better for a given disorder
on average, this does not really translate well to the
inidividual case. But, in general, no orientation has been shown to be "far superior" to another. (Well maybe DBT for Borderline). Some have been shown to work far quicker than others though
🙄.......which of course begs the ethical question of "Why subject a patient (financially) to 30 or 40 sessions of dynamic therapy when the lit shows that generally, this can be acomplished in 12-16 sessions of CBT? There is also a notorious consistency in the lit showing a
weak correlation between uncovering uncouncious conflict and providing the "corrective emotional experience" and subsequent behavior change. Moreover, about 70% of the variance in treatment outcome is due to the relationship between therapist and patient. Thus, your specific orientation is often a rather moot point anway. As Meehl said, "sometimes people need Ellis, sometimes people need Rogers, sometime people need Freud." This is my personal view as well. Different strokes for different folks.
I am also a big believer in the notion that just because there is no diagnosis or DSM code for "loniliness" or existential unhappiness does not mean that we dont need to treat them. The need for love, understanding, and compassion are all part of the human condition. I believe that sometimes this notion can get lost when approaches become manulaized for disorders and symptoms, rather than for the persons (cough, CBT, cough).
As an aside, Meehl also had an interesting view (consdering his reputation for "dustbowl empiricism") that since science was simply not advanced enough to understand the human psyche or the etiology of psych illness, all we can do for the time being is go with the one that
seems to work the best
on average. This seems to be CBT and RBT approaches by a very small margin. However, jsut because these approaches work does not equate to them being the truth of what is truly going on (ie., the dynamics and the etiology) since these approaches were developed strictly for psychological intervention and have no real underlying theory of personality. Meehl hypothesized that when science catches up, Freud's ideas would be the one that most closely apprixmate the nature of the troubled human psyche. This is a seductive notion, that frankly, I tend to agree with.
However, I must say that I reread one of my favorite papers just the other day.
http://drlinden.net/ccp606827.pdf. Carl Rogers wrote this in 1956 and it strikes me as odd how much of this is true, and how little more we know about the therapuetic process than we did back then. I see little evidence, ethier in the outrcome literature or in my clinical expereince, that anything else is indeed required to facilitate behavior change in at least semi-motivated patients.
