«This article provides commentary on Saul Rosenzweig’s classic 1936 paper, “Some Implicit Common Factors in Diverse Methods of Psychotherapy,” ...»
The Legacy of Saul Rosenzweig: The Profundity
of the Dodo Bird
Barry L. Duncan
Nova Southeastern University
This article provides commentary on Saul Rosenzweig’s classic 1936 paper,
“Some Implicit Common Factors in Diverse Methods of Psychotherapy,”
with particular emphasis on his clever and prophetic invocation of the dodo
bird verdict from Alice in Wonderland. The impact of this seminal contri-
bution is discussed by a comparison of Rosenzweig’s original common fac-
tors proposal with modern formulations of common factors. The paradox inherent to the tenacious veracity of the dodo bird verdict and the pursuit of empirically validated treatments are explored. In the spirit of Rosenzweig’s legacy and the wisdom of the dodo, this article suggests that psychotherapy abandon the empirically bankrupt pursuit of prescriptive interventions for specific disorders based on a medical model of psychopathology. Instead, a call is made for a systematic application of the common factors based on a relational model of client competence.
The great tragedy of Science—the slaying of a beautiful hypothesis by an ugly fact.—Thomas Henry Huxley (1825–1895) Although long enamored of common factors and their practical appli- cation to psychotherapy practice and integration (Duncan, Hubble, & Miller, 1997; Duncan & Miller, 2000b; Duncan & Moynihan, 1994; Duncan, Barry L. Duncan, School of Social and Systemic Studies, Nova Southeastern University.
I am indebted to Scott Miller, Jacqueline Sparks, and Mark Hubble for our many collaborations, the results of which are intertwined throughout this article. I also thank Jac- queline Sparks for invaluable comments on this article and Roberto Quiroz for library assis- tance.
Barry L. Duncan is now at the Institute for the Study of Therapeutic Change, Tamarac, Florida.
Correspondence concerning this article should be addressed to Barry L. Duncan, P.O.
Box 26231, Tamarac, Florida 33320. E-mail: email@example.com 32 Journal of Psychotherapy Integration Copyright 2002 by the Educational Publishing Foundation 2002, Vol. 12, No. 1, 32–57 1053-0479/02/$5.00 DOI: 10.1037//1053-0418.104.22.168 The Legacy of Saul Rosenzweig 33 Solovey, & Rusk, 1992; Hubble, Duncan, & Miller, 1999b; Miller, Duncan, & Hubble, 1997), I only recently read Saul Rosenzweig’s classic 1936 paper, “Some Implicit Common Factors in Diverse Methods of Psychotherapy.” Heretofore, I appreciated the article for its historical significance as the first known articulation of common factors in psychotherapy, which I had gleaned through others’ reference and interpretation (e.g., Goldfried & Newman, 1992; Luborsky, 1995; Weinberger, 1995). When the contribution to this volume motivated a long overdue first-hand look, I was more than surprised to find the dodo birdverdict from Alice in Wonderland used as an epigraph to begin Rosenzweig’s paper (see his explanation for that choice in this issue [Duncan, 2002]).
Recall that in Alice in Wonderland, Lewis Carroll (1865/1962) tells the story of a race that was run to help the animals dry off after they were soaked by Alice’s tears. The animals ran off helter-skelter in different directions, and the race was soon stopped. The dodo bird was asked, “Who has won?” And he finally exclaimed the now famous verdict, “Everybody has won, and all must have prizes.” The dodo bird’s pronouncement has become not only a metaphor for the state of psychotherapy outcome research but also a symbol of a raging controversy regarding the privileging of specific approaches for specific disorders based on demonstrated efficacy in randomized clinical trials (e.g., Chambless & Hollon, 1998;
Garfield, 1996; Goldfried & Wolfe, 1998; Hubble, Duncan, & Miller, 1999a;
Shapiro, 1996)—the so-called empirically validated treatments.
It is curious that few discussions of Rosenzweig’s (1936) article refer to his creative application of Carroll’s famous race. The often perfunctory accounts of Rosenzweig’s paper have perhaps missed its most profound element: the clever invocation of the verdict to describe the equivalence of effectiveness among psychotherapies. Many have attributed the colorful and illustrative application of the dodo bird’s judgment to Frank’s (1973) Persuasion and Healing. Perhaps most, however, have credited Luborsky, Singer, and Luborsky (1975) for its use in their groundbreaking summation of comparative studies of psychotherapy.
Although Luborsky et al. (1975) cited Rosenzweig’s original application in the second line of their own classic piece, most (with notable exceptions, e.g., Weinberger, 1993) are either unaware of or have overlooked or forgotten that credit. Taking nothing away from Luborksy et al., their invocation of the verdict was a perfect satiric fit because of the horse-race mentality of comparative studies, the scattered directions that various approaches uncritically traveled, and the resultant findings of no differences.
It was not until I read Rosenzweig’s (1936) article that I could grasp its amazing clairvoyance—Luborsky et al. (1975) empirically confirmed Rosenzweig’s crystal ball assessment of psychotherapy some 40 years earlier. He not only predicted nearly 65 years of data; Rosenzweig, in 1936, 34 Duncan presented the classic argument, still used today, for a common factors perspective—namely, because all approaches appear equal in effectiveness, there must be pantheoretical factors in operation that overshadow any perceived or presumed differences among approaches. In short, he discussed the factors common to therapy as an explanation for the observed comparable outcomes of varied approaches. His paper represents far more than an historical footnote in the evolution of a common factors perspective and deserves far more than an obligatory tip-of-the-cap reference, of which my colleagues and I are equally guilty.
This article provides commentary on Rosenzweig’s prophetic paper and its impact on contemporary psychotherapy. To accomplish this task, I compare Rosenzweig’s seminal contribution with modern formulations of common factors. The paradox inherent to the dodo bird verdict and the pursuit of empirically validated treatments is explored. Finally, in the spirit of Rosenzweig’s legacy and the wisdom of the dodo, this article suggests that psychotherapy abandon the empirically bankrupt pursuit of prescriptive interventions for specific disorders based on a medical model of psychopathology. Instead, a call is made for a systematic application of the common factors based on a relational model of client competence.
Beware lest you lose the substance by grasping at the shadow.—Aesop (620–560 B.C.) With Freud, psychotherapy was born. Yet, before he barely left a mark on the professional landscape, his former disciples broke ranks, proclaimed their theoretical differences, and promoted their own versions of mental life and therapy. Since those days, the divisions have multiplied. New schools of therapy now arrive with the regularity of the Book-of-the-Month Club’s main selection (Hubble et al., 1999b).
Dating from the 1960s, the number of psychotherapy approaches has grown approximately 600% (Miller et al., 1997). Although the actual figures vary among observers, it is estimated that there are now more than 200 therapy models and 400 techniques (Bergin & Garfield, 1994). Veteran common factors theorist and researcher Sol Garfield (1987) said, “I am inclined to predict that sometime in the next century there will be one form of psychotherapy for every adult in the Western World!” (p. 98). Most claim to be the corrective for all that came before, professing to have the inside line on human motivation, the true causes of psychological dysfunction, and the best remedies.
Once therapists broke the early taboo against observing and researchThe Legacy of Saul Rosenzweig 35 ing therapy, they turned to proving empirically that their therapies were the best. A generation of investigators ushered in the age of comparative clinical trials. Winners and losers were to be had. As Bergin and Lambert (1978) described this time, “Presumably, the one shown to be most effective will prove that position to be correct and will serve as a demonstration that the ‘losers’ should be persuaded to give up their views” (p. 162). Thus, behavior, psychoanalytic, client-centered or humanistic, rational–emotive, cognitive, time-limited, time-unlimited, and other therapies were pitted against each other in a great battle of the brands.
Nonetheless, all this sound and fury produced an unexpected bonfire of the vanities (Hubble et al., 1999b). Put another way, reiterating Huxley’s epigraph introducing this article, science slew a beautiful hypothesis with an ugly fact. As Rosenzweig spelled out more than 65 years ago, the underlying premise of the comparative studies, that one (or more) therapies would prove superior to others, received virtually no support (Bergin & Lambert, 1978; Sloane, Staples, Cristol, Yorkston, & Whipple, 1975). Besides the occasional significant finding for a particular therapy, the critical mass of data revealed no differences in effectiveness between the various treatments for psychological distress. Luborsky et al. (1975) reinvoked the dodo bird to describe the findings of their review of comparative studies.
Now, more than 25 years later and many attempts to dismiss or overturn it (see below), the dodo bird verdict still stands. Therapy works, but our understanding of what works in therapy is unlikely to be found in the insular explanations and a posteriori reasoning adopted by the different theoretical orientations.
There is no new thing under the sun.—Eccles. 1:9
Weinberger (1995) observed that after 1980, an outpouring of writing began to appear on the common factors. Grencavage and Norcross (1990) collected articles addressing common factors and noted that a positive relationship exists between year of publication and the number of common factors proposals offered. Perhaps in response to the comparative studies and reviews of the 1970s and 1980s (e.g., Luborsky et al., 1975; Shapiro & Shapiro, 1982; Smith, Glass, & Miller, 1980; Stiles, Shapiro, & Elliot, 1986) reflecting the equivalence of outcome, the 1980s gave rise to more prominence to common factors ideas, particularly in the eclecticism–integration movement. Many noteworthy common factors proposals have appeared (e.g., Arkowitz, 1992; Garfield, 1980; Goldfried, 1982; Miller et al., 1997;
Patterson, 1989; Weinberger, 1993).
36 Duncan Perhaps the most significant modern contribution to a common factors perspective was made by Michael Lambert. After an extensive review and analyses of decades of outcome research, Lambert (1992) identified four therapeutic factors (extratherapeutic, common factors, expectancy or placebo, and techniques) as the principal elements accounting for improvement in psychotherapy. Inspired by Lambert’s proposal, Miller et al. (1997) expanded the use of the term common factors from its traditional meaning of nonspecific or relational factors to include four specific factors: client, relationship, placebo, and technique. It is interesting that this interpretation of common factors represents a return to Rosenzweig’s original formulation. On the basis of this broader conceptual map of the common factors, Hubble et al. (1999b) assembled leading outcome researchers to review four decades of investigation and reveal its implications for practice.
The results favored an increased emphasis on the client’s contribution to positive outcome and provided a more specific delineation of clinical guidelines (Duncan & Miller, 2000b; Hubble et al., 1999a, 1999b). The following is a snapshot of the findings compared with Rosenzweig’s 1936 formulations.
Until lions have their historians, tales of hunting will always glorify the hunter.— African proverb Clients have long been portrayed as the “unactualized” message bearers of family dysfunction, manufacturers of resistance, and, in most therapeutic traditions, targets for the presumably all-important technical intervention.
Rarely is the client cast in the role of the chief agent of change or even mentioned in advertisements announcing the newest line of fashions in the therapy boutique of techniques (Duncan & Miller, 2000b). Tallman and Bohart’s (1999) review of the research makes clear, however, that the client is actually the single, most potent contributor to outcome in psychotherapy—the resources clients bring into the therapy room and what influences their lives outside it (Miller et al., 1997). These factors might include persistence, openness, faith, optimism, a supportive grandmother, or membership in a religious community—all factors operative in a client’s life before he or she enters therapy. They also include serendipitous interactions between such inner strengths and happenstance, such as a new job or a crisis successfully negotiated.
Assay and Lambert (1999) ascribed 40% of improvement during psychotherapy to client factors. This hefty percentage represents a departure from convention, considering that, as Tallman and Bohart (1999) indicated, most of what is written about therapy celebrates the contribution of the The Legacy of Saul Rosenzweig 37 therapist, therapist’s model, or technique. Revisiting the dodo bird verdict, Bohart (2000) decried the field’s persistent attempts to refute it and took the common factors interpretation of the verdict one step further. He asserted that therapies work equally well because they share one very important but classically ignored ingredient—the client and his or her own regenerative powers. The dodo bird verdict rings true, Bohart suggested, because the client’s abilities to change transcend any differences among models.
If this is so, reasoned Tallman and Bohart (1999), then other examples of the equivalence of outcome should occur. And they do. The dodo bird verdict prevails not only across different approaches to therapy but also between professionals and paraprofessionals (Strupp & Hadley, 1979), experienced and inexperienced therapists (Christensen & Jacobson, 1994), psychotherapy and self-help (Arkowitz, 1997), and self-help approaches (Gould & Clum, 1993).