Common Factors and the Nature of Mental Illness

Different methods of conducting psychotherapy might seem to imply a tension over the fundamentals of what constitutes psychotherapy: CBT on one side and psychodynamic therapy on the other. Aaron Beck, the founder of CBT, was deeply influenced by psychoanalytic theory, making him, in a sense, Freud's theoretical grandchild (Beck, 1991). This perceived tension, however, betrays an underlying naivete regarding what therapy is and is not.

In fact, both CBT and psychodynamic therapy, although meaningfully different in their use of rhetoric and theoretical understandings of mental health issues, are effective psychotherapies, meaning they both offer significant relief to their consumers (American Psychological Association, 2012; Shedler, 2010). The implication is that the principles of personality and personality change remain relatively constant across time, while the ways humans have gone about facilitating personality change have evolved.

In other words, when different modalities of therapy create relief for clients, they likely do so for overlapping reasons. This is referred to as the “common factors” theory of psychotherapy, and research provides substantial support for the importance of common factors across therapeutic approaches (Frank & Frank, 1991; Wampold & Imel, 2015). It is also true that when therapies fail, they may fail for unique reasons related to the application of their particular theories and methods of facilitating psychological change.

Tolstoy's opening to Anna Karenina can therefore be loosely applied to what we know about psychotherapy modalities: “Happy families are all alike; every unhappy family is unhappy in its own way” (Tolstoy, 1878/2000). Successful psychotherapies may share

fundamental ingredients, while unsuccessful treatments may fail in distinct ways.

References

American Psychological Association. (2012). Recognition of psychotherapy effectiveness. https://www.apa.org/about/policy/resolution-psychotherapy

Beck, A. T. (1991). Cognitive therapy: A 30-year retrospective. American Psychologist, 46(4), 368–375. https://doi.org/10.1037/0003-066X.46.4.368

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

Shedler, J. (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65(2), 98–109. https://doi.org/10.1037/a0018378

Tolstoy, L. (2000). Anna Karenina (R. Pevear & L. Volokhonsky, Trans.). Penguin Classics. (Original work published 1878)

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work (2nd ed.). Routledge.