Books and Articles on General and Comparative Counselling and Psychotherapy Research

This section includes general and comparative research in counselling and psychotherapy, including research on effectiveness and efficacy.

Theory and Research in Counselling and Psychotherapy

General and Comparative

Asay, T.P. and M.J. Lambert (1999) 'The Empirical Case for the Common Factors in Therapy: Quantitative Findings', in Hubble et al. (1999).

This chapter provides an excellent survey of empirical data supporting Lambert's (1992) observation that therapeutic change is around 40% due to client and extratherapeutic variables, 30% due to relationship factors, 15% due to expectancy and hope factors, and 15% due to the techniques and models of individual approaches.

Bachelor, A. (1988) 'How Clients Perceive Therapist Empathy: A Content Analysis of 'Received' Empathy', Psychotherapy: Theory, Research and Practice 25: 227-40.

Underscoring the central importantce of client perceptions of what therapists think they are offering, this study indicates significant variation between clients in terms of what is perceived as meaningful therapist empathy. Around 44% of clients specifically valued a cognitive type of empathic response, whereby the therapist indicates an understanding of the client's subjective state or motivation. About 30% valued an affective-tyle response, whereby the therapist indicates they are themselves participating in the same feeling the client is expressing. Finally, about one quarter took empathy to be either a sharing of personal information via relevant self-disclosure or the offering of a particularly nurturing or supportive response. Bottom line: there is no one form of empathy, and what is an effective style of empathic response for one client may not be empathy at all for another client.

Bachelor, A. (1995) 'Clients' Perception of the Therapeutic Alliance: A Qualitative Analysis', Journl of Counseling Psychology 42: 323-37.

This study found three relatively different types of relationship that were deemed to be therapeutic, depending on the individual client; in other words, whether a relationship is therapeutic is to be found -- not surprisingly! -- in the eye of the client and not in a specific set of relationship conditions offered by the therapist as a one-size-fits-all package.

Bachelor, A. and A. Horvath (1999) 'The Therapeutic Relationship', in Hubble et al. (1999), pp. 133-78.

As a concise exploration of empirical evidence on the importance of the relationship in the therapeutic process, I can think of no better article than this. (Note that by 'the relationship', I do not mean the therapist behaviours or attitudes which might be believed to lead, inevitably, to the formation of a good relationship -- such as, say, the core conditions of the person-centred approach -- I mean the relationship itself.) This articles explores a wide range of variables, both client variables and therapist variables, which contribute to the quality of the therapeutic relationship and really highlights the importance of attending to that relationship itself. My only complaint is that the chapter wasn't longer! Also see Tallman and Bohart (1999), from the same volume, on the client as a common factor.

Barkham, M. (2002) 'Methods, Outcomes and Processes in the Psychological Therapies across Four Successive Research Generations', in Dryden (2002a), pp. 373-433.

Barkham provides a nice historical overview of the development of psychotherapy research, identifying the principle concerns driving each of four generations and describing key developments and publications from each era. The overview is split into two halves, with one covering international research and the other focusing specifically on Britain. The bibliography is very comprehensive.

Bergin, A.E. and S.L. Garfield, eds. (1994) Handbook of Psychotherapy and Behavior Change, 4th Edition. New York: Wiley. [Amazon UK | Amazon US]

Regarded as the textbook of research on the effectiveness of counselling and psychotherapy, this volume is a favourite of practitioners who approach their work in an empirical spirit. While tracing research developments gradually as individual papers appear remains an important part of being well-informed about the field, the meta-analyses offered in this massive volume provide a very efficient entree into the research literature and a simple way of understanding the primary themes and tentative conclusions emerging from empirical research across the world. One area of particular interest given current debates on professional accreditation is that on counsellor experience, and here the book will make sobering reading for anyone who believes that accreditation schemes, degrees, years of experience, or particulars of theoretical orientation offer any assurance at all of therapeutic effectiveness. Empirical evidence fails to offer any clear support for these beliefs. (See in particular Beutler et al. and pp. 169-172 of Lambert and Bergin in this volume.) Few could argue that the empirical evidence about the effectiveness of counselling and psychotherapy remains seriously incomplete, but nonetheless it is something, and at this point the empirical data cast a very harsh light on the claims of partisans of accreditation and exponents of particular schools of counselling thought. Given the currently available evidence, such claims are best understood as expressions of faith, not statements grounded in the empirical substance of science. Debate over the merits of accreditation-type schemes is exceedingly heated, but for one view in favour of quite heavy regulation, see chapter 6 of Syme (1994); for a very strong view against, see Mowbray (1995). Of course, there is much much more of interest in this volume than this particular area!

Beutler, L.E.; P.P.P. Machado and S. Allstetter Neufeldt (1994) 'Therapist Variables', in Bergin and Garfield (1994), pp. 229-69.

This large review of cross-study correlational data on therapist characteristics suggests, among other things, that levels of training and therapist experience are virtually irrelevant to therapeutic outcome; that therapist directiveness, while helpful in certain cases, is in the general case significantly counterproductive (i.e., inhibits therapeutic outcome); and that therapist warmth and supportiveness facilitates therapeutic success. Also see Lambert and Bergin (1994), pp. 172-5 for important observations about characteristics of individual therapists, as opposed to correlational data across studies.

Bordin, E.S. (1979) 'The Generalizability of the Psychoanalytic Concept of the Working Alliance', Psychotherapy: Theory, Research and Practice 16(3): 252-60.

Bordin originated a view of the therapeutic alliance as consisting of three components: bonds, goals and tasks. This view is used as a framework in Dryden's (1990b) comparative look at several different approaches to counselling and psychotherapy.

Christensen, A. and N.S. Jacobson (1994) 'Who (Or What) Can Do Psychotherapy: The Status and Challenge of Nonprofessional Therapies', Psychological Science 5: 8-14.

Several reviews indicate no evidence for significant differences in effectiveness between professionals and paraprofessionals providing psychotherapy. Moreover, empirical evidence fails to support the view that more experienced therapists are more effective.

Consumer Reports (1995) 'Mental Health: Does Therapy Help?', Consumer Reports (November): 734-9.

This is the widely-discussed Consumer Reports article, based upon survey responses from 22,000 readers, indicating that 1) clients benefit very substantially from psychotherapy, 2) longer-term treatment is significantly more effective than short-term treatment, and 3) psychotherapy alone does not differ in effectiveness from medication plus psychotherapy. See Seligman (1995) for a very useful analysis.

Crouch, A. (1997) Inside Counselling: Becoming and Being a Professional Counsellor. London: Sage. [Amazon UK-hardcover | Amazon UK-paperback | Amazon US-hardcover | Amazon US-paperback]

This fascinating book is difficult to categorize; it deserves a section all its own, it's just that I wouldn't know what to call that section. It's a fictional account of counselling written from the inside out, as it were. While it does include discussions, and questions to ponder, most of the volume involves case studies or therapeutic exchanges or journal extracts, often explicitly incorporating details of what given characters are thinking. This book is more full of genuine reflections from the author, and more likely to provoke the reader to ponder and reflect, than almost any book on counselling I have encountered. It's probably best read any time after about halfway through a counselling training course, including after decades of experience.

Dryden, W. (1990a) Individual Therapy: A Handbook. Milton Keynes: Open University Press.

See Dryden (2002a) for a newer edition of this same book. The 1990 edition is notable for its inclusion of the comparative essay (Dryden 1990b) omitted from later versions.

Dryden, W. (1990b) 'Approaches to Individual Therapy: Some Comparative Reflections', in Dryden (1990a), pp. 273-281.

Based on interviews with the authors of articles on 11 different therapeutic approaches covered in Dryden (1990a), this comparative chapter was dropped from later editions of the book. The chapter provides a very succinct comparison of several different approches to counselling and psychotherapy in terms of Bordin's (1979) framework for the therapeutic alliance and its three components of bonds, goals and tasks. Because it is based on interviews with individual authors, the comparison may be somewhat coloured by particular features of those individual authors' views about their fields, but nonetheless the comparison provides a valuable starting point from which more detailed explorations could be undertaken.

Dryden, W., ed. (2002a) Handbook of Individual Therapy, 4th Edition. London: Sage. [Amazon UK-hardcover | Amazon UK-paperback | Amazon US-hardcover | Amazon US-paperback]

Published in its first edition as Individual Therapy in Britain (1984), its second as Individual Therapy: A Handbook (Dryden 1990a), and its third (1996) with the same title as the fourth, this book is an excellent overview of the primary theoretical approaches to counselling and psychotherapy as practised in the United Kingdom. Covering history, theory, primary client set and strengths and weaknesses for each of thirteen different approaches, the book is an excellent starting point for exploring different schools of thought in more detail. Students interested in an explicit comparison of different approaches should consult the second edition, since the relevant chapter (Dryden 1990b) was omitted from subsequent editions after requests from those running training programmes. Compare also Feltham and Horton (2000).

Eysenck, H.J. (1952) 'The Effects of Psychotherapy: An Evaluation', Journal of Consulting Psychology 16: 319-24.

Eysenck's original critical study suggested that improvement rates over a two-year period for clients presenting with neurotic problems were virtually unaffected by being offered psychotherapy. Although later shown very convincingly to be methodologically flawed, the study helped mobilize an army of researchers to investigate therapeutic effectiveness more carefully, an undertaking which continues unabated.

Feltham, C., ed. (2002) What's the Good of Counselling & Psychotherapy?: The Benefits Explained. London: Sage. [Amazon UK-hardcover | Amazon UK-paperback | Amazon US-hardcover | Amazon US-paperback]

While suffering somewhat from a lack of focus, the individual contributions of this 16-chapter edited volume nonetheless make worthwhile reading in and of themselves. This book is reviewed separately at CounsellingResource.com.

Feltham, C. and I. Horton, eds. (2000) Handbook of Counselling and Psychotherapy. London: Sage. [Amazon UK-hardcover | Amazon UK-paperback | Amazon US-hardcover | Amazon US-paperback]

This massive (788 pages) volume is almost encyclopaedic in nature, covering not only a wide range of different approaches to counselling and psychotherapy, but also general therapeutic skills, issues surrounding professional and personal development, the working environment, a range of specific client problems, and specialisms. The book also includes a section on current trends and critiques. While the treatment of specific approaches to counselling and psychotherapy is markedly less comprehensive than Dryden (2002a), overall coverage of the field is distinctly broader.

Greenberg, L.S. and W.M. Pinsof, eds. (1986) The Psychotherapeutic Process: A Research Handbook. London: Guildford Press. [Amazon UK | Amazon US]

Also see the more recently updated Bergin and Garfield (1994).

Gurman, A.S. and A.M. Razin, eds. (1977) Effective Psychotherapy: A Handbook of Research. New York: Pergamon.

This is the core volume of what Barkham (2002) describes as 'Generation II' (out of IV) of psychotherapy research, research which focused on specificity in outcome and therapeutic process. The newer Bergin and Garfield (1994) now serves as a more comprehensive 'Bible' of recent research.

Hubble, M.; B.L. Duncan and S.D. Miller, eds. (1999) The Heart & Soul of Change: What Works in Therapy. Washington, D.C.: American Psychological Association.[Amazon UK | Amazon US]

This collection strongly suggests that therapeutic effectiveness is much more strongly influenced by pantheoretical, or common factors, than by the specialized techniques or procedures of individual approaches to counselling or psychotherapy. This book is reviewed separately at CounsellingResource.com.

Jacobson, N. (1995) 'The Overselling of Therapy', Family Therapy Networker 19: 40-51.

This study indicates no significant difference in terms of effectiveness at providing couples therapy between novice graduate students and fully-trained professionals.

Kovel, J. (1976) A Complete Guide to Therapy: From Psychoanalysis to Behaviour Modification. London: Penguin.

This book is now clearly outdated, and contemporary readers may find it hard to recognize some of Kovel's descriptions of various approaches to psychotherapy. And while the book aims to explore a range of different approaches even-handedly, it is plainly written from the perspective of a psychoanalyst; those from other approaches may find Kovel's critiques a little exasperating at times. But it is exactly for this kind of reason that the book is worth picking up: the mix of psychoanalytic critiques, interludes on Marxism and the political milieu of the 1970s, and even ethical positions which are no longer mainstream provides a worthwhile challenge to today's practitioner. In other words, the mere fact that there is so much to disagree with, so much to identify as outmoded, so much to struggle to understand, makes it worth a quick read!

Krupnick, J.L. et al. (1996) 'The Role of the Therapeutic Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Insitute of Mental Health Treatment of Depression Collaborative Research Program', Journal of Consulting and Clinical Psychology 64: 532-39.

Based on the TDCRP, this study -- the largest study of therapeutic alliance and outcome ever conducted -- revealed a very large impact on outcome deriving from the therapeutic alliance, an impact which held across all four treatment modalities of the TDCRP (cognitive-behavioural therapy, interpersonal psychotherapy, imipramine plus clinical management, and a pill-placebo plus clinical management control condition). As they put it, "the role that the therapeutic alliance plays in affecting outcome extends not only beyond psychodynamic psychotherapy to cognitive behavior therapy, but also beyond psychotherapy itself, with implications for the way in which pharmacotherapy is conceptualized and practiced" (p. 537).

Kutash, I. and A. Wolf, eds. (1986) Psychotherapist's Casebook. San Francisco: Jossey-Bass. [Amazon UK | Amazon US]

Covering a range of different approaches to psychotherapy, this book avoids the Anglo-centricity of Dryden (2002a). It includes many case examples to illustrate the approaches in practice.

Lambert, M.J. (1992) 'Implications of Outcome Research for Psychotherapy Integration', in Norcross and Goldstein (1992), pp. 94-129.

This chapter first provided Lambert's empirically very well-grounded but ever-so-unpopular estimate that therapeutic change is around 40% due to client and extratherapeutic variables, 30% due to relationship factors, 15% due to expectancy and hope factors, and 15% due to the techniques and models of individual approaches. See Hubble et al. (1999) for much more on common factors.

Lambert, M.J. and A.E. Bergin (1994) 'The Effectiveness of Psychotherapy', in Bergin and Garfield (1994), pp. 143-89.

This is an excellent review of meta-analyses of studies on psychotherapeutic efficacy. While very rich in information, one item of particular note is the clear finding that "there is only modest evidence to suggest the superiority of one school or technique over another" (p. 161). The authors suggest several alternative explanations for the "general finding of no-difference", including 1) different therapies can achieve similar goals through different processes, 2) different outcomes do occur but are not detected by past research strategies, and 3) different therapies embody common factors that are curative although not emphasized by the theory of change central to a particular school (p. 161). Unfortunately, current evidence does not permit these explanations (or some other) to be distinguished. Of particular interest to the person-centred approach is the observation that "Reviewers are virtually unanimous in their opinion that the therapist-patient relationship is critical; however, they point out that research support for this position is more ambiguous than once thought" (pp. 164-65). Finally, the authors' observations about the importance of individual therapist quality are notable; in several studies and meta-analyses, individual therapist effects accounted for a very large portion of outcome variance -- in other words, the abilities of individual therapists turned out to be more important than most other factors (including their theoretical orientation). While the evidence remains too thin on the ground to draw strong conclusions directly from the data, it is not at all far-fetched to say there is little to suggest that particular therapies are more effective, only that particular therapists are more effective.

Luborsky, L.; B. Singer and L. Luborsky (1975) 'Comparative Studies of Psychotherapies: Is it True That "Everybody Has Won and All Must Have Prizes"?', Archives of General Psychiatry 32: 995-1008.

It was here that the authors first proposed their now-vamous 'dodo bird verdict', borrowing from Lewis Carroll, reflecting the fact that outcome studies have clearly shown that no one system of psychotherapy has distinguished itself as any more effective than the rest.

Marchington-Yeoman, C. and C.L. Cooper (2002) 'The Benefits of Counselling and Employee Assistance Programmes to British Industry', in Feltham (2002), pp. 211-224.

After reviewing the primarily US-based EAP research and its almost universally positive findings for the benefits of counselling and employee assistance programmes, the authors report on their large scale quantitative and qualitative study of UK schemes. While research on the field is still in its infancy, the research is nonetheless very encouraging and already offers worthwhile conclusions which should be taken into account by every business either running or planning to launch a counselling or EAP service.

Mitchell, K.M.; J.D. Bozarth and C.C. Krauft (1977) 'A Reappraisal of the Therapeutic Effectiveness of Accurate Empathy, Nonpossessive Warmth, and Genuineness', in Gurman and Razin (1977), pp. 482-502.

In this frequently-cited review of research on empathy and the other person-centred 'core conditions', the authors conclude that on balance, the evidence "neither supports nor rejects the overriding influence of such variables as empathy" (p. 483) and suggest that evidence supporting the effectiveness of the core conditions is no longer as clear as once thought. (Also see Lambert and Bergin (1994), especially pp. 164-165.)

Norcross, J.C. and M.R. Goldstein, eds. (1992) Handbook of Psychotherapy Integration. New York: Basic Books. [Amazon UK | Amazon US]

Rice, L.N. and G.P. Kerr (1986) 'Client and Therapist Vocal Quality', in Greenberg and Pinsof (1986), pp. 77-105.

Of particular interest to telephone counsellors, this study of clients' perceptions of counsellors' effectiveness indicates how a counsellor's vocal quality bears on his or her ability to deliver 'good therapy' (itself analysed in terms of conveyance of the counsellor's state, his or her modelling of a process allowing client material to be explored, and the specific messages delivered through his or her interaction with the client). Seven vocal qualities are defined, including softened (adequate energy but relaxed vocal muscles), irregular (varying pace and pitch), natural, definite (full and assured), restricted (adequate energy but restrained), patterned (rising or level pitch at the end of a phrase, rather than the normal lowering), and limited (low energy or flat). The upshot of the study is that the softened, irregular and natural categories are preferred, while the limited and restricted categories fail to convey interest and are too distancing, respectively. The patterned vocal quality can block expressiveness and exploration or convey a lack of sensitivity, while the definite quality can deter the client from disagreeing with the counsellor.

Rosenfield, M. (1997) Counselling By Telephone. London: Sage. [Amazon UK-hardcover | Amazon UK-paperback | Amazon US-hardcover] | Amazon US-paperback]

As one of the Professional Skills for Counsellors series, this book tends toward the more basic end of the spectrum, although this is one where that characteristic is particularly noticeable. Nonetheless, this volume provides a valuable introduction to the ways in which telephone counselling differs from traditional face to face counselling. In particular, it explores the many benefits of telephone counselling for both client and counsellor, and it highlights the areas in which counsellors may need to upskill in order to provide a good telephone service. The book also distinguishes effectively between the use of telephone counselling skills and the provision of actual telephone counselling.

Seligman, M.E.P. (1995) 'The Effectiveness of Psychotherapy: The Consumer Reports Study', American Psychologist 50 (12): 965-74.

The author distinguishes the efficacy study from the less-stringent but more realistic effectiveness study, analyses the merits and methodological shortcomings of the Consumer Reports study (1995), and concludes that the study provides very valuable empirical validation of the effectiveness of psychotherapy.

Svartberg, M. and T.C. Stiles (1994) 'Therapeutic Alliance, Therapeutic Competence, and Client Change in Short-Term Anxiety-Provoking Psychotherapy', Psychotherapy Research 4: 20-33.

Meta-analysis of studies on short-term psychodynamic therapy suggests that inexperienced therapists are actually more effective than their more experienced colleagues.

Tallman, K. and A.C. Bohart (1999) 'The Client as a Common Factor: Clients as Self-Healers', in Hubble et al. (1999), pp. 91-131.

For a lesson on the empirical evidence for why the single most important factor in therapy is the client, this chapter is outstanding! In referring to the 'dodo bird verdict', the conclusion that all psychotherapies appear roughly equally effective in outcome studies, the authors suggest that, "the most parsimonious explanation for the dodo bird verdict is that it is the client, not the therapist or technique, that makes therapy work" (p. 91). Much like the contribution from Bachelor and Horvath (1999) in the same volume, this chapter also makes it apparent that focusing on the importance of the client means much more than simply adopting the person-centred approach to psychotherapy; in a very real sense, the person-centred approach does not begin to do the client the same level of justice as this article suggests should be possible by paying attention to the empirical evidence, evidence about the factors that make the client the real "'engine' that makes therapy work" (p. 91).

   

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This page was last reviewed by Dr Greg Mulhauser, Saturday, 11 November 2017.