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The Great Psychotherapy Debate
The Great Psychotherapy Debate: Models, Methods, and Findings comprehensively reviews the research on psychotherapy to dispute the commonly held view that the benefits of psychotherapy are derived from the specific ingredients contained in a given treatment (medical model). The author reviews the literature related to the absolute efficacy of psychotherapy, the relative efficacy of various treatments, the specificity of ingredients contained in established therapies, effects due to common factors, such as the working alliance, adherence and allegiance to the therapeutic protocol, and effects that are produced by different therapists. In each case, the evidence convincingly corroborates the contextual model and disconfirms the prevailing medical model.
278 pages, Hardcover
First published March 1, 2001
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765 people want to read
About the author
Bruce E. Wampold
27 books11 followersBruce E. Wampold is the Patricia L. Wolleat Professor of Counseling Psychology and clinical professor of psychiatry at the University of Wisconsin—Madison.
Wampold is known for developing the contextual model of psychotherapy, which constitutes an alternative to the prevailing theory of the effectiveness of psychotherapy, known as the medical model.
Wampold is a fellow of the American Psychological Association, and received the Association's Award for Distinguished Professional Contributions to Applied Research in 2007.
Wampold is known for developing the contextual model of psychotherapy, which constitutes an alternative to the prevailing theory of the effectiveness of psychotherapy, known as the medical model.
Wampold is a fellow of the American Psychological Association, and received the Association's Award for Distinguished Professional Contributions to Applied Research in 2007.
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Displaying 1 - 18 of 18 reviews
November 29, 2019
Bruce Wampold has compiled and summarized research that should interest every mental health clinician, as he outlines the factors that bring about therapeutic change. I used to be skeptical of the dodo bird verdict, but Wampold has convinced me otherwise. For an introduction to his work, you might want to read this article, as his book here gets incredibly granular.
April 29, 2019
Psychotherapy works and for some disorders can be as effective (or more) than medications.
Why does it work? When does it work? These are the big questions plaguing the field and, although these answers sound like they should be easy to find, they haven't been.
The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work compares the Medical Model (i.e., a disorder, a scientifically based explanation of the disorder, a mechanism of change, and specific therapeutic actions) with the Contextual Model (i.e., the therapeutic relationship is foundational to psychotherapy's effectiveness).
Single studies suggest that specific psychotherapy approaches are more successful than other types. Wampold and Imel examine the research carefully, reviewing meta-analyses of large number of studies (examining a large number of studies on a single issue to identify trends). What they found is that if confounds are controlled for (e.g., allegiance to a therapeutic approach, the believability of the comparison group), psychotherapy is more effective than no treatment, but different approaches to psychotherapy are often no more effective than each other. Wampold and Imel convincingly conclude that the Contextual Model explains change from psychotherapy, while predictions of the Medical Model are not supported.
When do clients change? Therapists must offer a treatment that is coherent, explanatory, and facilitates clients' engagement during treatment to change their lives.
The ending of Wampold and Imel was somewhat surprising. After demonstrating that even well-accepted treatments such as cognitive-behavioral therapy are no more effective than each other, and that the effect sizes for empathy, the client/therapist alliance, positive regard, the therapist, and expectations are each greater than that for specific ingredients to therapy, Wampold and Imel conclude:
[Psychotherapy] training that focuses on treatments and ignores relationship skills (the “how” of treatment), ignores the research evidence about what makes therapy effective. But it is also detrimental for trainees to learn relationship skills to the exclusion of learning particular approaches to psychotherapy. The optimal training programs will combine training in treatments and relationships skills—this is a scientific approach to training. (p. 276)
What should clients consider as they choose a therapist? As they evaluate their current therapist Do the patient and the therapist agree on the goals of therapy and the tasks needed to achieve those goals?—that is, is there a collaborative working relationship? ...[D]oes the patient feel understood and respected? (p. 276)
This is an often difficult book, not necessarily because of Wampold and Imel's writing, but meta-analyses and the identification and disentanglement of research confounds is difficult. Nonetheless, this was a good and important read.
Why does it work? When does it work? These are the big questions plaguing the field and, although these answers sound like they should be easy to find, they haven't been.
The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work compares the Medical Model (i.e., a disorder, a scientifically based explanation of the disorder, a mechanism of change, and specific therapeutic actions) with the Contextual Model (i.e., the therapeutic relationship is foundational to psychotherapy's effectiveness).
Single studies suggest that specific psychotherapy approaches are more successful than other types. Wampold and Imel examine the research carefully, reviewing meta-analyses of large number of studies (examining a large number of studies on a single issue to identify trends). What they found is that if confounds are controlled for (e.g., allegiance to a therapeutic approach, the believability of the comparison group), psychotherapy is more effective than no treatment, but different approaches to psychotherapy are often no more effective than each other. Wampold and Imel convincingly conclude that the Contextual Model explains change from psychotherapy, while predictions of the Medical Model are not supported.
When do clients change? Therapists must offer a treatment that is coherent, explanatory, and facilitates clients' engagement during treatment to change their lives.
The ending of Wampold and Imel was somewhat surprising. After demonstrating that even well-accepted treatments such as cognitive-behavioral therapy are no more effective than each other, and that the effect sizes for empathy, the client/therapist alliance, positive regard, the therapist, and expectations are each greater than that for specific ingredients to therapy, Wampold and Imel conclude:
[Psychotherapy] training that focuses on treatments and ignores relationship skills (the “how” of treatment), ignores the research evidence about what makes therapy effective. But it is also detrimental for trainees to learn relationship skills to the exclusion of learning particular approaches to psychotherapy. The optimal training programs will combine training in treatments and relationships skills—this is a scientific approach to training. (p. 276)
What should clients consider as they choose a therapist? As they evaluate their current therapist Do the patient and the therapist agree on the goals of therapy and the tasks needed to achieve those goals?—that is, is there a collaborative working relationship? ...[D]oes the patient feel understood and respected? (p. 276)
This is an often difficult book, not necessarily because of Wampold and Imel's writing, but meta-analyses and the identification and disentanglement of research confounds is difficult. Nonetheless, this was a good and important read.
April 26, 2020
If you are genuinely interested in knowing what works in psychotherapy without all the factional babble between schools of thought, this is that book. If you are a practitioner wondering why the concepts advocated for by most mainstream researchers (Evidence based practice REEEEEEE) add so little useful insight to your everyday work, this book answers why: the research has not been asking the right questions. Questions are being asked from a 'Medical model' where there is a specific deficit that a specific therapy is going to fix, which this book argues is a fundamentally misleading way to look at it. This book evaluates the assumptions behind psychotherapy research, explores the philosophy of science, critiques the hegemony of CBT (the 'gold standard' therapy), and offers great viable alternatives catering to researchers, policymakers, and practitioners of all walks. Overall, Wampold demonstrated great understanding of what happens in a therapy session, great understanding of science's philosophy, great literacy in quantitative research (especially meta-analyses), broad understanding of therapy theories and their related research. This might not be the most appealing writing, but it does exudes assurance that this is useful and top quality writing.
Pros: Extremely comprehensive. It is a very academic text, but the jargon usage isn't too jarring. If the reader is genuinely interested in any of the terms, Wampold makes sure that the meaning is accessible most of the time. The chapters are also very detailed, covering aspects such as history of psychotherapy, ways of understanding the evidence, efficacy of approaches, therapist effects, expectations, specific ingredients, and research designs. This allows Wampold to launch a comprehensive assault on the Medical Model and making a great case for using the Contextual Model.
Cons: Despite the title, isn't so much a debate: Wampold's Contextual model is obviously shown to be by far and large superior over the Medical Model. This means that if you are expecting an interesting back and forth of arguments as a reader, the Medical Model goes out in a whimper even in the early chapters. Another related flaw in the writing is that the main points are already clarified in the early few chapters, leaving the rest of the book sound like a broken record as Wampold reiterates points again and again. The points stated in the earlier chapters are promised to be elaborated on, only to be lead to mountains of academic research (imagine 'Results' segments of academic articles on a non-stop loop with some 'Discussion') that doesn't add much to the main points of the Contextual Model. Effectively the elaborations are academic evidence for his points, but they don't add much depth from a pragmatic standpoint.
I guess it might be unfair to take away points for being 'too academic', considering the book itself does not pretend to be popular science. But the reiteration of well-established points non-stop for such a dense text does make for a subpar reading experience. That being said, this book should be required reading for any educational program of psychotherapy that claims to value research. It saves researchers and practitioners time and effort by putting them on the same page without researchers accusing practitioners of not understanding research and not acting on evidence based practice, or practitioners accusing researchers of being out of touch with reality. All in all, the ideas in this book is incredibly important. This would be better if there was a different revision that caters to practitioners and real life situations.
Pros: Extremely comprehensive. It is a very academic text, but the jargon usage isn't too jarring. If the reader is genuinely interested in any of the terms, Wampold makes sure that the meaning is accessible most of the time. The chapters are also very detailed, covering aspects such as history of psychotherapy, ways of understanding the evidence, efficacy of approaches, therapist effects, expectations, specific ingredients, and research designs. This allows Wampold to launch a comprehensive assault on the Medical Model and making a great case for using the Contextual Model.
Cons: Despite the title, isn't so much a debate: Wampold's Contextual model is obviously shown to be by far and large superior over the Medical Model. This means that if you are expecting an interesting back and forth of arguments as a reader, the Medical Model goes out in a whimper even in the early chapters. Another related flaw in the writing is that the main points are already clarified in the early few chapters, leaving the rest of the book sound like a broken record as Wampold reiterates points again and again. The points stated in the earlier chapters are promised to be elaborated on, only to be lead to mountains of academic research (imagine 'Results' segments of academic articles on a non-stop loop with some 'Discussion') that doesn't add much to the main points of the Contextual Model. Effectively the elaborations are academic evidence for his points, but they don't add much depth from a pragmatic standpoint.
I guess it might be unfair to take away points for being 'too academic', considering the book itself does not pretend to be popular science. But the reiteration of well-established points non-stop for such a dense text does make for a subpar reading experience. That being said, this book should be required reading for any educational program of psychotherapy that claims to value research. It saves researchers and practitioners time and effort by putting them on the same page without researchers accusing practitioners of not understanding research and not acting on evidence based practice, or practitioners accusing researchers of being out of touch with reality. All in all, the ideas in this book is incredibly important. This would be better if there was a different revision that caters to practitioners and real life situations.
December 25, 2022
Kertakaikkiaan loistava kirja. Psykoterapian nykyajan supertähti Wambold esittelee erittäin vakuuttavasti ja perustellusti argumenttinsa siitä, miksi psykoterapia toimii. Kaikkea en vielä sisäistänyt, mutta tulen palaamaan teoksen pariin vielä useasti.
Paikoitellen kirja oli hieman vaikeaselkoinen lukuisine tutkimusviittauksineen, mutta kuulunee asiaan. Painavat väitteet vaativat painavat perustelut.
Mielestäni must-read terapiatyön ammattilaisille.
Paikoitellen kirja oli hieman vaikeaselkoinen lukuisine tutkimusviittauksineen, mutta kuulunee asiaan. Painavat väitteet vaativat painavat perustelut.
Mielestäni must-read terapiatyön ammattilaisille.
April 24, 2009
Okay, this book is not for the psychologically faint-of-heart. It's long, it's complex, it's full of research results and it's really, really dull unless you are very curious about what direction therapy should go next.
If you're thinking about graduate school in psychology, you should read this first.
If you're thinking about graduate school in psychology, you should read this first.
July 6, 2024
If I had to sum my thoughts about The Great Psychotherapy Debate in one sentence, it would be this: This guy gets it.
Bruce E. Wampold's The Great Psychotherapy Debate is a book on the Contextual Model of Psychotherapy, a model describing how the shared factors of different psychotherapeutic approaches may yield similar results despite different theories and methods.
Reading Wampold's book was a great relief. I've had a lot of issues with my field's teaching and research over the years. Many courses and studies have felt narrow-minded and biased, highlighting the pros of individual methods with minimal support to back up the claims.
With The Great Psychotherapy Debate and the Contextual Model, I feel like I've finally found a formal approach that fits in my worldview well enough. Yet instead of focusing on the negative, the book gives a compassionate look on different approaches. Wampold focuses on building bridges, not walls.
Reading about the Contextual Model has been very meaningful for me. Still, I wouldn't give the book as a whole five stars. Individual chapters work well enough, but reading the whole book can be tedious as there's a lot of repetition. The hefty price ($40 for an ebook rental) also makes the book quite inaccessible for many.
Bruce E. Wampold's The Great Psychotherapy Debate is a book on the Contextual Model of Psychotherapy, a model describing how the shared factors of different psychotherapeutic approaches may yield similar results despite different theories and methods.
Reading Wampold's book was a great relief. I've had a lot of issues with my field's teaching and research over the years. Many courses and studies have felt narrow-minded and biased, highlighting the pros of individual methods with minimal support to back up the claims.
With The Great Psychotherapy Debate and the Contextual Model, I feel like I've finally found a formal approach that fits in my worldview well enough. Yet instead of focusing on the negative, the book gives a compassionate look on different approaches. Wampold focuses on building bridges, not walls.
Reading about the Contextual Model has been very meaningful for me. Still, I wouldn't give the book as a whole five stars. Individual chapters work well enough, but reading the whole book can be tedious as there's a lot of repetition. The hefty price ($40 for an ebook rental) also makes the book quite inaccessible for many.
April 2, 2021
This book should have been a paper...
Here is what you need to know: "the relationship between the therapist and the client that occurs in the context of a treatment is critical to the success of therapy (...) Three pathways through which the benefits of psychotherapy are achieved: the real relationship, the creation of expectations through explanation and agreement about the tasks and goals of psychotherapy, and the facilitation of psychologically beneficial process of some kind". (pp.255-256)
Here is what you need to know: "the relationship between the therapist and the client that occurs in the context of a treatment is critical to the success of therapy (...) Three pathways through which the benefits of psychotherapy are achieved: the real relationship, the creation of expectations through explanation and agreement about the tasks and goals of psychotherapy, and the facilitation of psychologically beneficial process of some kind". (pp.255-256)
September 17, 2015
One of my all time favorites.....
November 3, 2022
Holy fuck. Huge if true. Basically, the effects of psychotherapy are almost entirely due to only two factors:
1. The "real relationship". This is the empathetic connection between the client and therapist, that aims towards making things better.
2. Expectation. The expectation of getting better that comes with understanding your situation. Actually – not even that. You only have to FEEL you understand your situation. I guess a consequence of this is that even bogus explanations (like astrology) do the trick if they are believable to the client.
A few implications: There are no differences in effectiveness between therapies. Therapist skill really matters. How tightly a therapist adheres to a particular therapy doesn't matter. Empathy REALLY matters.
Terrifying tbh.
Is the power of CBT mainly in its believability? The fact that it uses scientific terminology in an age where science = truth?
I still don't really know how much of this book is true, but neither does the author. He explains that he's open to the evidence and remains skeptical. A true scientist!!
I left with a lot of questions. Like, if a client has zero ability to think critically, would they receive equal benefit from an astrological explanation of their psychological issues as they would from a widely-accepted practice like CBT? Maybe even MORE benefit? I mean, the hippy-type is often repelled by scientific jargon like "cognitive" etc. Perhaps CBT would be less convincing than astrology. Anyway. Banger.
1. The "real relationship". This is the empathetic connection between the client and therapist, that aims towards making things better.
2. Expectation. The expectation of getting better that comes with understanding your situation. Actually – not even that. You only have to FEEL you understand your situation. I guess a consequence of this is that even bogus explanations (like astrology) do the trick if they are believable to the client.
A few implications: There are no differences in effectiveness between therapies. Therapist skill really matters. How tightly a therapist adheres to a particular therapy doesn't matter. Empathy REALLY matters.
Terrifying tbh.
Is the power of CBT mainly in its believability? The fact that it uses scientific terminology in an age where science = truth?
I still don't really know how much of this book is true, but neither does the author. He explains that he's open to the evidence and remains skeptical. A true scientist!!
I left with a lot of questions. Like, if a client has zero ability to think critically, would they receive equal benefit from an astrological explanation of their psychological issues as they would from a widely-accepted practice like CBT? Maybe even MORE benefit? I mean, the hippy-type is often repelled by scientific jargon like "cognitive" etc. Perhaps CBT would be less convincing than astrology. Anyway. Banger.
July 19, 2018
The best book on the topic, by far. A cogent summary of all the evidence on psychotherapy. What do we know? Psychotherapy works, very well. There is no difference in effectiveness between different types of therapy. There is a vast difference in effectiveness between different therapists. What's important is the alliance between therapist and client--which is emotional-relational, but also cognitive, in that they are aligned on the idea of what is going on for the client and what will help. This book should be the nail in the coffin for the medical model of psychotherapy; it just isn't supported by science. Whereas the contextual model is. The implications of this book are massive, in terms of what research gets funded, what psychotherapy is approved by insurance plans, and how psychotherapists are taught. All of those things are tethered to the medical model. They should be realigned with the contextual model. Wampold is thorough, scrupulous and clear. He also is transparent about the implications of his work and sets forth recommendations that are no-nonsense. Anyone interested in psychotherapy must read this. It's an essential work.
June 13, 2025
This man has annalyzed everything that exists in the world of psychology - you made a small study with 20 participants in the mountains of Himalaya back in 1999? Good, it's part of his meta analysis.
It was quite eye-opening and very helpful to get an actual idea of how this field works statistically, especially when you get bombarded with hundred of ideas from every direction and everyone claims they have the solution to all problems and answers to all questions.
The only drawback might be that it is very technical in its style and Wampold inludes a lot and I mean a lot of numbers and context for everything, but I belei ve it is justified and adds to the core idea of the book.
It was quite eye-opening and very helpful to get an actual idea of how this field works statistically, especially when you get bombarded with hundred of ideas from every direction and everyone claims they have the solution to all problems and answers to all questions.
The only drawback might be that it is very technical in its style and Wampold inludes a lot and I mean a lot of numbers and context for everything, but I belei ve it is justified and adds to the core idea of the book.
January 2, 2022
Recommended for practitioners, however can get a bit too heavy
September 30, 2024
Must read para todo psicólogo clínico.
July 29, 2015
An extremely methodical examination of the experimental evidence for-and-against the idea that the benefits of psychotherapies are due to their common factors rather than their specific ingredients.
This book is somewhat mathsy. I managed to read it without complete understanding of the statistical terms. I felt that I still understood the findings even if I did not grasp the technical minutiae. If you are intimidated by occasional equations or statistical terms then you might prefer the more recent and less methodical "Essential Research Findings in Counselling and Psychotherapy: The Facts Are Friendly" by Mick Cooper.
The author does a pretty good job of expressing both sides of an argument on which he has obviously come down on one side. The image I now have (as a trainee counsellor) is that the specific ingredients of genuine psychotherapies are a vector for the common factors that all competent therapists bring to their clients. In a way, this massively simplifies the selection of which therapeutic model to learn about and practice because rather than having to say, "Which model really works?" we only have to ask, "Which model really speaks to me?"
This book is somewhat mathsy. I managed to read it without complete understanding of the statistical terms. I felt that I still understood the findings even if I did not grasp the technical minutiae. If you are intimidated by occasional equations or statistical terms then you might prefer the more recent and less methodical "Essential Research Findings in Counselling and Psychotherapy: The Facts Are Friendly" by Mick Cooper.
The author does a pretty good job of expressing both sides of an argument on which he has obviously come down on one side. The image I now have (as a trainee counsellor) is that the specific ingredients of genuine psychotherapies are a vector for the common factors that all competent therapists bring to their clients. In a way, this massively simplifies the selection of which therapeutic model to learn about and practice because rather than having to say, "Which model really works?" we only have to ask, "Which model really speaks to me?"
August 5, 2009
This is an excellent review of the "does psychotherapy work" literature circa 2000 with an unequivocal answer -- YES. Furthermore, and most germane to the point of the book, all credible psychotherapy models work equally well, most likely because they share contextual features:
The components common to all [effective:] therapies include (a) an emotionally charged confiding situation with a helping person; (b) a healing setting that involves the client's expectations that the professional helper will assist him of her; (c) a rationale, conceptual scheme, or myth that provides a plausible, although not necessarily true, explanation of the client's symptoms and how the client can overcome his or her demoralization; and (d) a ritual or procedure that requires the active participation of both client and therapist and is based on the rational underlying the therapy.
A technical albeit rewarding read.
The components common to all [effective:] therapies include (a) an emotionally charged confiding situation with a helping person; (b) a healing setting that involves the client's expectations that the professional helper will assist him of her; (c) a rationale, conceptual scheme, or myth that provides a plausible, although not necessarily true, explanation of the client's symptoms and how the client can overcome his or her demoralization; and (d) a ritual or procedure that requires the active participation of both client and therapist and is based on the rational underlying the therapy.
A technical albeit rewarding read.
August 14, 2016
Daca iti place sa practici psihoterapia pe bajbaite, e o abordare care pana la urma poate o sa dea roade, dar poate sa treaca mult prea mult timp pana gasesti reteta perfecta. In schimb, daca vrei sa mergi la tinta afla ce s-a intamplat inaintea ta, mai ales ca acum avem acces la informatii la un click distanta. Caile care duc in zid nu ar mai trebui batute, daca exista evidente pentru asta. Poate ca teama de a fi ales gresit te poate face sa preferi sa bajbai, insa aceasta carte este un sprijin real. Intri in contact cu ceea ce functioneaza in psihoterapie in 2015, inveti istoria a ceea ce s-a intamplat in 100+ ani de cercetari, afli care e situatia actuala si pornesti de aici pe calea potrivita pentru tine. Este un manifest pentru terapia adaptata fiecarui client, in loc de abordarea care presupune ca toti suntem identici si ni se potriveste acelasi tip de tratament. O carte revelatoare si ma opresc aici.
April 23, 2021
Offers a broad view of the world of psychotherapy research and some interesting and insightful material about science and medicine. On the other hand, the writing is often undisciplined, written without the reader sufficiently in mind, which detracts significantly from the overall credibility. I am sympathetic to the authors’ views but came away from the book with the sense that the whole debate is one big political power game and that even the authors’ contextual model retains some rationalist baggage.
Displaying 1 - 18 of 18 reviews