of Psychotherapy: How Are They Related?
In Chap.3, we mentioned the current debate (Wampold & Imel,2015) in psycho- therapy research: one group of scientists considers the nonspecific“common factors” as the major forces of therapeutic change, whereas the other group maintains that specific techniques are responsible for change. It has already become clear in our discussion that neither of the two groups can ultimately prevail because the nonspecific and specific change factors are both necessary ingredients of psycho- therapy and commonly depend on one another in a hierarchical fashion. Unspecific common factors unfold their impact at a level that differs from the specific-technique level of intervention. At the same time, however, the higher level depends on the lower level so that we are confronted with coexistence rather than clear-cut antag- onism. This is represented by the vertical arrows in Fig.6.3. Common factors, i.e., contextual interventions, and techniques, i.e., specific interventions, however, have
Fig. 6.3 Diagram of how the traditional distinction of common factors versus specific techniques (red boxes) relates to the Fokker-Planck model (blue boxes). Common factors and specific techniques are located at different levels of the hierarchy of therapeutic interventions (vertical arrows). Common factors have deterministic effects of the contextual type, whereas techniques have specific deterministic effects
6.6 Deterministic and Stochastic Interventions Versus Specific Techniques. . . 77
different profiles of action. Together with the stochastic inputs, this amounts to a three-factor conceptualization of therapeutic interventions and impacts.
The specific-nonspecific debate is not identical to our distinction of the determin- istic and stochastic components of the Fokker-Planck model of therapeutic interven- tion. The adherents of the nonspecific mechanisms in psychotherapy prefer a philosophy of human change due to which the therapist can only provide a nonspecific context for a“social healing”process (Wampold,2015). In this view, therapy offers the prerequisites for change, but the client has to do the changing all by him- or herself. The therapist hermeneutically and indirectly supports the change process and the solution of problems, but will not decide on the direction and concrete goals of change. The theoretical background of this nonspecific theory of psychotherapy can be linked to the assumption of growth motivations and self- actualization (in humanistic-experiential therapies) or to constructivist or autopoietic epistemological assumptions in systemic therapies (Maturana & Varela,1980). In the extreme“postmodern”version of constructivism, the client is the only expert for finding solutions, and the therapist’s function is just catalytic—to mobilize the client’s resources to do this (de Shazer,1991). In our model, such nonspecific and nondirective interventions can be effective (if they are in fact effective) only through contextual effects, i.e., by modifying the affordances of the self-organizing system.
Therefore, we likewise counted such interventions among the deterministic inter- ventions (Fig.6.3).
In addressing the stochastic effects of therapeutic interventions, we found that numerous deterministic interventions at either hierarchical level also possess ele- ments that increase Q, the diffusion parameter of the Fokker-Planck equation.
Deterministic and stochastic components of therapeutic interventions cannot be completely disentangled—causationandchance coexist in psychotherapy process.
Interventions in psychotherapy commonly consist, at varying ratios, of a mixture of both components. This observation provides an important argument for our choice of the Fokker-Planck model in describing psychotherapy process, because this model- ing approach combines both causation and chance. Thus, in Fig. 6.3 both the common factors and the specific techniques additionally contribute to the regulation of stochastic inputs.
In our discussion in Chaps. 5 and 6, we found that the four major therapy approaches have differing profiles of action because they prefer different types of interventions. In Table 6.1 we illustrate these profiles. We also point out the prototypical effect on attractors and on state space volumes for each of the three types of interventions and inputs.
Table6.1shows that different therapy approaches are not restricted to a specific andfixed type of intervention. There is a choice, and likely there are various roads that may lead to positive outcomes, even within the same therapy approach. This is not to say that the road to take is arbitrary. We will therefore address the common- alities of the different roads of treatment in the next chapter: How can a therapist, within his or her treatment concept, decide on the most appropriate mixture of deterministic and/or stochastic interventions for a given problem? When should a therapist use contextual interventions?
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Table 6.1 Overview of intervention types in psychotherapy, summing up the discussion of Chaps.5and6.Size of symbols scales with the significance of an intervention for the respective therapy approach (BT, behavioral psychotherapies; Psa, psychoanalysis and psychodynamic psy- chotherapies; HEP, humanistic-experiential therapies; SPT, systemic psychotherapies)
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