Escape from Babel Toward a Unifying Language for Psychotherapy Practice

by Barry L. Duncan

While "psychotherapy" has been busily dividing into hundreds of different models, research shows that it doesn't really matter which approach you use, which guru you follow, or which fancy techniques you adopt. Yet there are some factors, across models, that do matter. The authors want readers to shake their allegiance to masters and models and focus on these basics, from which emerges a unifying language for psychotherapy practice. So what does matter? First, respect for the client's point of view, understanding of the problem, ideas about its solution, and interaction with chance events that affect its course. The client is here seen as the unsung hero of psychotherapy. Second, the authors focus on the therapeutic relationship, which research shows matters more than therapeutic orientation or technique. Third, successful clients have hope and a plan for the future, which can be nurtured in the therapeutic relationship. Finally, there is a place for techniques and models to provide structure and introduce novelty in therapy. This is a simple but effective approach, illustrated here in short vignettes and two extended cases.

Genres: Psychology, Nonfiction, Mental Health

Hardcover

First published December 17, 1996

Reviews

[Brandt · Rating 3 out of 5]

Although not completely conceptualized until the concluding summary of the book, the title, Escape from Babel: Toward a Unifying Language for Psychotherapy Practice, is a biblical reference that alludes towards a characterization of the competing doctrines in psychotherapy at the twilight of the 20th Century.

Within the multitude of contending theories and models, each replete with their own distinctive verbiage and techniques, Scott D. Miller, Barry L. Duncan, and Mark A. Hubble suggest that a voice of unification can be found through focusing on the common factors that emanate from under each theories penumbra. Further, the already existing and thorough research literature on effective therapeutic approaches and outcomes provide the critical ingredients to efficiently and effectively work in the helping relationship.

Even though each treatment promises a new and superior process of therapy, Miller et al. (1996) suggest that nearly half a century of research has failed to find “any one theory, model, method, or package of techniques to be reliably better than any other” (Lambert & Bergin, 1994, as cited in Miller, Duncan, & Hubble, 1996). Moreover, research conducted by Doherty and Simmons (1995; 1996), Lambert and Bergin (1994), and Shadish et al. (1993) suggest that “All of the data” indicates that each approach works about equally. Hence, “The differences between the various models simply do not make much difference in therapy outcome” (Miller et al, 1996 p. 2).

As presented in the text, many practitioners profess an intoxicating belief in primarily inane theories of human development and behavior. In turn, these beliefs often imprint an explanation of clinical problems that conform to the preconceived theoretical construct the practitioner is working from. The pattern is practically unmistakable; it is as though the impulsivity, misinterpretations of human motivation, and the desire to exaggerate the effective power of psychotherapy models have doomed the field to interpretative nonsense. Additionally, the present milieu of managed care; cost over benefit, and brief interventions have contributed to the desire to find the quickest solution to a complex issue.

In response to the crises of modern psychotherapy, the author’s suggest that the answer can be found in a unification of the language in psychotherapy. In fact, regardless of the theoretical position embraced by the therapist, there are enough commonalities amongst theoretical models to formulate successful psychotherapeutic practices. Most importantly, this language embraces, what the research suggests, is the client’s perspective on the most helpful aspects of their experience; viz. “being respected, being understood and being cared for” (Lambert, personal communication, 1992, as cited in Miller et al. 1996, p. 23). Moreover, “clients also expect their therapists not to be bound to any one brand or language of treatment” (Miller et al. 1996, p. 23).

Of particular interest is the author’s presentation of Lambert’s (1992) four common curative elements of a unifying language in psychotherapy: “(1) extratherapeutic factors; (2) therapy relationship factors; (3) model and technique factors; and (4) expectancy, hope, and placebo factors” (Miller et al., 1996, p. 24). Each one of these elements is explained, in detail, and assigned a percentage based on research.

First, extratherapeutic factors, defined as “the client’s contribution to outcomes” are estimated at making up a major portion of the elements at 40%. As such, “extratherapeutic factors are the cornerstone of the unifying language for psychotherapy practice” (Miller et al, 1996, p. 26).

Next, it is suggested that the therapeutic relationship contributes about 30% towards the variance of outcomes in therapy. The importance of the therapy relationship is so vital that Strupp (1995) suggested, “the quality of the interpersonal context is the sine qua non in all forms of psychotherapy” (Strupp, 1995, p. 70, as cited in Miller et al. p. 27, Emphasis in the original). Not surprisingly, research indicates that the “core conditions” of empathy, respect, and genuineness, as extolled by eminent psychotherapist Carl Rogers (1951), when matched with the client’s understanding of these terms, and the client’s rating of the therapeutic alliance, produce the second highest contribution towards the outcomes of therapy (Bachelor, 1988; Duncan, Solovey, & Rusk, 1992; Hovarth & Lurborsky, 1993; Orlinsky, Grawe, & Parks, 1994, as cited in Miller et al. 1996).

Next, contributing around 15% towards the outcomes of therapy is the element of therapeutic technique. While all therapists make use of technical procedures, most of these processes are based on “preparing clients to take some actions to help themselves” (Miller et al, 1996, p. 29). Consequently, the techniques used by the variant models can stop being utilized to compare and contrast; contrariwise, they can become “vehicles for enhancing the effects of the other common factors” (Miller et al., 1996, p. 30).

Lastly, the element of expectancy, hope, and placebo make up the remaining 15% of the therapeutic outcome. Research conducted by Goleman (1991), Frank and Frank (1991), and Snyder, Irving, and Anderson (1991), reveals that expectancy and hope bestow innumerable advantages in many areas of living. For example, a client’s expectation that therapy will help them, actually improves therapeutic outcome (Frank & Frank, 1991). Further, “fostering a positive expectation for change may actually be a prerequisite for successful treatment” (Snyder et al., 1991. As cited in Miller et al., 1991, p. 31).

Using the four common curative elements of a unifying language in psychotherapy, the author’s present a fascinating argument that attempts to make sense of the research and produce positive outcomes in therapy. In attempting to unify the language of psychotherapy, the intention is to merge the multitude of disciplines and develop these commonalities into a process that can truly help relieve the suffering and solve the problems that bring the client into the relationship with the practitioner.

Happy Reading!

References

Bachelor, A. (1988). How clients perceive therapist empathy. Psychotherapy, 25, 227-240.

Doherty, W.J., & Simmons, D.S. (January, 1995). Clinical practice patterns of marriage and
family therapy: A national survey of therapists and their clients. Journal of Marital and Family Therapy, 21(1), 3-16.

Doherty, W.J., & Simmons, D.S. (January, 1996). Clinical practice patterns of marriage and family therapy: A national survey of therapists and their clients. Journal of Marital and Family Therapy 22(1), 9-26.

Duncan, B.L., Solovey, A.D., & Rusk, G.S. (1992). Changing the rules: A client-directed approach to therapy. New York: Guilford.

Frank, J.D., & Frank, J.B. (1991). Persuasion and healing: A comparative study of psychotherapy (3rd ed.). Baltimore, MD: John Hopkins University Press.

Goleman, D. (December 24, 1991). In new research optimism is the key to a successful life.New York Times, B5-6.

Hovarth, A.O., & Luborsky, L. (1993). The role of the alliance in psychotherapy. Journal of Consulting and Clinical Psychology, 61, 561-573.

Lambert, M.J. (1992). Implications of outcome research for psychotherapy integration. In J.C. Norcross & M.R. Goldfried (Eds.), Handbook of psychotherapy integration. New York: Basic.

Lambert, M.J. & Bergin, A.E. (1994). The effectiveness of psychotherapy. In A.E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.

Miller, S.D., Duncan, B.L., & Huble, M.A. (1996). Escape from Babel: Toward a unifying language for psychotherapy practice. New York: W.W. Norton & Company, Inc.

Orlinsky, D.E., Grawe, K., & Parks, B.K. (1994). Process and outcomes in psychotherapy – noch einmal. In A.E. Bergin & S.L. Garfield (Eds.), Handbook of psychotherapy and behavior change (4th ed.). New York: Wiley.

Rogers, C.R. (1951). Client centered therapy: Its current practice, theory, and implications. Chicago, IL: Houghton Mifflin.

Shadish, W.R., Montgomery, L.M., Wilson, P., Wilson, M.R., Bright, I., & Okwumabua, T. (1993). Effects of family and marital psychotherapies: A meta-analysis. Journal of Consulting and Clinical Psychology, 61, 992-1002.

Snyder, C.R., Irving, L.M., & Anderson, J.R., (1991). Hope and health. In C.R. Snyder & D.R. Forsyth (Eds.), Handbook of social and clinical psychology. New York: Pergamon.

Strupp, H.H. (1995). The psychotherapist’s skills revisited. Clinical Psychology, 2, 70-74.

[Aimee · Rating 4 out of 5]

This book examines the four main, researched measures on successful reported outcomes of therapy. 1) Extratheraputic factors - 40% 2) Client-Therapist Relationship - 30% 3) Techniques and Interventions - 15% 4) Expectancy & Holding Hope - 15%.

Reading it actually relieved me as I have been saturated with theory through my studies, particularly this last quarter. 30% of success reported by the client comes from the relationship they believe to have with the therapist. The anxiety of feeling like you have perform in the room is significantly reduced when you read that success is perceived as doing the basic therapeutic skills like empathy, sincere listening, authenticity. How easily we forget what is important while sitting with people.

Overall, it is a really quick read and for a textbook it is very easy to digest and actually fairly interesting to read.

[Mary · Rating 5 out of 5]

For being an older book, it is highly relevant to learning the art of helping in 2022. I love how the authors explore the common therapeutic factors and present it with research. They remind the reader that all of the fancy theories, models, and techniques are but appendages to being present, listening, and responding to the client. And I like how much they emphasized that it is the client, not the therapist, that initiates and brings change. So many theories and models are all about the therapist and really, the person is the one who is engaged in changing.

[Heiki Eesmaa · Rating 3 out of 5]

I feel like the common factors literature has moved on and superseded this book. Were it not for this, I'd give it four stars, cause otherwise it's good and engaging. Just not a timeless classic.

[Spencer · Rating 4 out of 5]

There's no shortage of theories of counseling out there today, and as the authors of this book see it, that factionalism is hurting the profession. Drawing on extensive research, they identify the four factors responsible for counseling success, regardless of theoretical orientation, and show how skillful counselors integrate these factors into their practice.

It's a good book, and great for a counselor or social worker in training. Many of their claims are grounded thoroughly in research; however, now and again, the authors venture outside of what is supported by evidence and make some ludicrous claims. For instance, at one point, they cynically cite the significant growth of the DSM as evidence of a belief that "we are sick and getting sicker", and use that as a springboard to rail against the medical model of counseling. It doesn't seem to occur to the authors that the DSM might have grown simply because we expanded our awareness of disorders, and that one can criticize pathology-oriented mindsets without making shaky interpretations of a diagnostic tool.

That said, it's a worthwhile, easy read with an important take on the practice of counseling.

[Olivia Kienzel · Rating 4 out of 5]

excellent book. read it for a course almost a year ago, and i loved what it had to say about the commonalities found in any good counselling practice. everyone interested in the field, as a consumer and as a practioner, should have a read--it's very inspiring.

[Austin · Rating 5 out of 5]

Great review of the common factors in therapy.