What is Effective in the Therapeutic Process?

Psychotherapy contains many hypothetical assumptions that have never been subjected to experimental validation. This is largely because the therapeutic interpersonal relationship on which psychotherapy is based embraces sundry variables that do not lend themselves to measurement. It is difficult, consequently, to apply to an evaluative study of psychotherapy the precise principles on which scientific method is based—namely, an unprejudiced compilation of facts and information, the formulation of reasonable hypotheses, the retention of objectivity in observation, and the retesting of findings with an attempt to reduplicate results. For the most part, descriptions of what goes on in therapy reflect the personal values and convictions of the observer. The clinical attitudes expressed are more pragmatic and empiric than they are scientific.

It is confounding, therefore, to observe among the different schools of psychiatric thinking self-appointed disciples of a transcendental wisdom who espouse their cherished theories with as great zeal as they denounce the contributions of other schools. This is all the more difficult to understand in view of the fact that available statistical data admit no virtuosity to any one school or cluster of techniques. Patients seem to be benefited by all known methods of treatment, provided that the practitioner is sufficiently skilled and experienced in his particular approach. It is possible then that what makes for success in treatment are factors other than those encompassed by specific theoretic and methodologic systems, factors which all good psychotherapies seem to have in common.

What exactly these factors are we cannot at our present state of knowledge know, but observation of the protocols of treatment sessions of a variety of patients benefiting from different kinds of psychotherapy indicates that improvement or cure is to a large extent due to a restoration of the patient's sense of mastery. This results from