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We are very far from the day when we will be able to specify the appropriate mixture of therapeutic approaches to be applied to a single patient (i.e. fitting the patient to the therapy). A commitment to eclectic or multi-modal psychotherapy is gaining ground within the discipline of psychotherapy (London 1972, Lazarus 1981, Goldfried 1982, Messer 1986). The mildest form that such integration may take is the differential therapy-oriented diagnosis of an individual patient. Implicitly the diagnostician conceives of certain patients as suffering from disorders which are oriented towards cognitive therapy whilst others have ‘deeper’ psychotherapeutically based problems. In this vein Murray (1976), for example, asserted that symptoms such as circumscribed phobias or specific sexual dysfunctions arise out of traumatic events and exist within a ‘sound personality structure’. Murray further claims that hysteria and obsessivecompulsive neurosis constitute disorders where symptoms are aspects of underlying personality disorder, ego functioning is fragile, inter-personal problems are prominent and an in-depth dynamic approach is more appropriate. Similiar suggestions have been made by Marks and Gelder (1966), Woody (1968), Marmor (1971), Bowers (1980) Messer and Winokur (1980, 1984, 1986). Ann Douglas' paper in the last issue of the Journal is a further example of this distinguished tradition.
One can well understand the motivation behind this approach, the wish of the clinician with integrity to help each patient with the most powerful technique conceivably applicable to the person's problems as formulated by the therapist. Most practising clinicians are forced by limitations of available facilities to make decisions about the type of therapy they regard as most likely to be of benefit to a particular patient. The difficulty of fitting the treatment to the patient is simply that, notwithstanding considerable empirical research devoted to this issue, no simple formula has been