Today's topic is the thorny question of Logotherapy and Evidence Based Practices. When I started to practice, any professional therapist was expected to keep up to date with the latest scientific findings in the field. Of course, therapists ethically remain responsible for the techniques they use in their practices.
However, during the 1990’s, we saw the development of managed care. Third party payors became assertive in stating what forms of therapy they would and would not pay for. In the last decade, this has developed into the concept of evidence based practices, or EBPs. The idea is that a payor source, an insurance company, for example, will not pay for a form of therapy unless there is scientific evidence that it works. Different payors maintain their own lists of EBPs and the lists are not the same.
The US Federal government list is the National Registry of Evidence Based Programs and Practices maintained by the Substance Abuse and Mental Health Services Administration of the US Dept. of Health and Human Services. The list is at:
http://www.nrepp.samhsa.gov/
Another list is maintained by the Society of Clinical Psychology, which is Division 12 of the American Psychological Association. Their website is at:
http://www.PsychologicalTreatments.org
Logotherapy has yet to appear as an evidence based treatment in any of the lists, despite the fact that research is continually ongoing in logotherapy and among logotherapists. A list of scientific journals on logotherapy is maintained by the Scientific Society for Logotherapy and Existential Analysis at the Viktor Frankl Institute Vienna at:
http://www.viktorfrankl.org/e/periodicals.html
On the other side of the debate, another body of research stresses the therapeutic factors related to outcome. Consistent findings over many years demonstrate that differences among the various therapy models do not translate into differences in therapy outcomes. In fact, the preponderance of the evidence suggests that no meaningful differences exist among the various schools and forms of therapy.
Division 29, the Division of Psychotherapy, of the American Psychological Association has an interesting article presently posted on its website at:
http://www.divisionofpsychotherapy.org/wampold-2006/
The importance of the therapeutic relationship can be illustrated by this clinical example cited by Viktor Frankl at the First World Congress of Logotherapy:
"An American girl, a student of music, came to see me in Vienna for analysis. Since she spoke a terrible slang of which I could not understand a word, I tried to turn her over to an American physician in order to have him find out for me what had motivated her to seek my advice. She did not consult him, however, and when we happened to meet each other on the street, she explained: "See, Doctor, as soon as I had spoken to you of my problem, I felt such a relief that I didn't need help any longer." So I do not know even now for what reason she had come to me. This was an extreme example when human encounter, without any technique, was therapeutic."
In 1992, M.J. Lambert found 4 factors were responsible for psychotherapy outcome.
1. Extratherapeutic factors account for 40% of the positive change. These are factors not directly related to therapy at all. They include the strengths and resources of the client as well as random, chance happenings.
2. The therapeutic relationship accounts for 30% of the positive change. This refers to the quality of the relationship between the therapist and the client. Therapist factors include qualities such as empathy, respect and genuineness. Client factors include readiness for change, goals for therapy and the client's view of the quality of the relationship (not the therapist's view).
3. Specific therapeutic techniques account for 15% of the positive change.
4. Some combination of hope and the placebo effect account for the remaining 15% of change.
So what are we to make of this for logotherapy? Recently, I have started to speculate that the effectiveness we see with logotherapy is not because of the effect logotherapy has on the client, but on the effect logotherapy has on the therapist. Simply put, I believe that studying logotherapy makes us better therapists!
Bibliography
Lambert, M. J. (1992). Implications of outcome research for psychotherapy integration. In J. C. Norcross and M. R. Goldfriend (Eds.),
Handbook of psychotherapy integration. New York: Basic
Wampold, B. E. (2006). Three ways to improve our effectiveness. In
News you can use. Washington: APA Division 29. Online:
http://www.divisionofpsychotherapy.org/wampold-2006/
See also:
Miller, S. D., Duncan, B. L., & Hubble, M. A. (1997).
Escape from babel: Toward a unifying language for psychotherapy practice. New York: W. W. Norton & Company.
Norcross, J. C. (Ed.). (2002).
Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. New York: Oxford University Press.
Wampold, B. E. (2001).
The great psychotherapy debate: Model, methods, and findings. Mahway, NJ: Lawrence Erlbaum Associates.
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