Whatever Happened to Carl Rogers ? An Examination of the Politics of Clinical Psychology

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Whatever Happened to Carl Rogers?
An Examination of the Politics of Clinical Psychology

A Chapter from the Upcoming Book:

HUMANISTIC PSYCHOLOGY: A CLINICAL MANIFESTO
A Critique of Clinical Psychology and the Need for Progressive Alternatives

By
David N. Elkins, Ph.D.
© Copyright David N. Elkins

To be published by
University of the Rockies Press
Colorado Springs, CO
Louis Hoffman, Editor


Praise from Natalie Rogers: “I read your excellent chapter and found myself saying
BRAVO! I agree that the medical model is well-entrenched and resisting Carl’s
discoveries. This article is long overdue and I am truly grateful for your careful and
important analysis of the situation in academic clinical psychology here in the United
States. On each page I found myself saying, “Yes! True! I agree! and thank you!” (See
Natalie Rogers’s website at http://www.nrogers.com/carlrogers.html)
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MAKING COPIES OF THIS CHAPTER: This chapter may be copied and distributed
freely provided all the information on this page about the upcoming book, along with the
copyright notification, is included on all copies exactly as shown on this original. This is
intellectual property owned by David N. Elkins and no one may sell this material to
others under any circumstances. Dr. Elkins’s intent is that the chapter be circulated free
of charge to all interested individuals, groups, and organizations.

HOW TO ORDER THE UPCOMING BOOK: Contact David Elkins at
davidnelkins@hotmail.com and ask to be placed on the “no obligation” pre-publication
list. You will be notified by e-mail when the book is available and can decide at that
point if you wish to purchase it. Other chapters include “The Medical Model in
Psychotherapy: Its Limitations and Failures,” “Empirically Supported Treatments: The
Deconstruction of a Myth,” and “Why Humanistic Psychology Lost Its Power and
Influence in American Psychology.” The book is a hard-hitting critique of contemporary
clinical psychology and shows how humanistic psychology can provide alternative
perspectives that are in line with contemporary research on what actually heals in
psychotherapy. Dr. Elkins is a clinical psychologist and professor emeritus of
psychology in the Graduate School of Education and Psychology at Pepperdine
© Copyright David N. Elkins, 2008

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University. He has been active in humanistic psychology for many years and has written
numerous articles on humanistic themes, published a book on humanistic spirituality
(Beyond Religion, Quest Books, 1998), served as a board member of the Association for
Humanistic Psychology (AHP), and was president in 1998-1999 of Division 32, Society
of Humanistic Psychology, of the American Psychological Association.
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Chapter One

Whatever Happened to Carl Rogers?
An Examination of the Politics of Clinical Psychology


Contemporary clinical psychology doesn’t quite know what to do with Carl
Rogers. On the one hand, it is widely acknowledged that Rogers changed the landscape
of American psychology. Rogers authored 16 books, published more than 200 scholarly
articles, gave hundreds of professional presentations, and engaged in public dialogues
with some of the most influential thinkers of his era including Martin
Buber and Paul Tillich (Kirschenbaum, 1979; Kirschenbaum & Henderson, 1989; N.
Rogers, 2008)
Rogers’s theories have had an impact on education, social work, nursing, counseling,
psychotherapy, group
therapy, peace efforts, and interpersonal relations. His theories have generated more
research than those of
any other clinical psychologist in American history (Bozarth, Zimring. & Tausch, 2001;
Kirschenbaum, 1979). Rogers and his contributions are recognized internationally and he
received awards and honorary degrees from dozens of groups, organizations, and
institutions at home and abroad. The American Psychological Association (APA) gave
Rogers two of its most prestigious awards – the “Award for Distinguished Scientific
Contributions” in 1956 and the “Award for Distinguished Professional Contributions to
Psychology” in 1972. He was the first psychologist in history to receive both awards
(Cain, 2001a). In a 1982 survey of psychologists conducted by the American
Psychologist (see Smith, 1982), Rogers was named as the most influential
psychotherapist and 25 years later, in a survey conducted by the Psychotherapy
Networker (April/March, 2007), Rogers was again ranked number one. Also, in a study
by Haggbloom et al. (2002) that ranked the 100 most eminent psychologists of the
twentieth century based on multiple criteria that included professional psychology journal
citations, introductory psychology textbook citations, and survey responses from
members of the American Psychological Society, Rogers received an overall ranking of
six and for clinicians he was second only to Sigmund Freud. In his later years Rogers
conducted group workshops in Northern Ireland and South Africa in an effort to promote
communication and understanding. For these efforts, he was nominated for the Nobel
Peace Prize in 1987 (Cain, 2001a).

It would be difficult to overestimate the significance of Rogers’s contributions
to clinical psychology. Often called the “father of psychotherapy research,” he was the
first to record and analyze the transcripts of actual therapy sessions in an effort to clarify
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what makes for effective psychotherapy; he was the first clinician to conduct major
studies on psychotherapy using quantitative methods; he was the first to formulate a
comprehensive theory of personality and psychotherapy grounded in empirical research;
he was the first to develop a theory of psychotherapy that de-emphasized pathology and
that focused, instead, on the strengths and potentials of clients (Rogers, 1987; Bozarth,
Zimring. & Tausch, 2001; Cain, 2001a). Today, Rogers’s ideas are echoed every time
psychologists talk about the importance of the therapeutic relationship, raise concerns
about the medical model, discuss the significance of the personal qualities of the
therapist, or mention the importance of contextual factors in therapeutic outcome (see
Wampold, 2000). Even Seligman’s “Positive Psychology,” a contemporary movement
that has attracted hundreds of psychologists, is little more than a reframing of Rogers’s
original emphasis on the strengths and potentials of clients (see Greening & Bohart,
2001; Resnick, Warmoth, & Serlin, 2001; Seligman & Csikszentmihalyi, 2000; Elkins, in
press - b).

The Question Addressed in This Chapter

In light of his many contributions, one would think that a large number of
contemporary clinical psychologists would embrace client-centered perspectives and that
Rogers and his ideas would be an important part of all training programs in clinical
psychology. This, however, is not the case. The truth is, only 10% of clinical
psychologists identify themselves as “humanistic” and client-centered therapists are a
subset of that group (Cain, 2001b). Further, many training programs in clinical
psychology marginalize or ignore Rogers and his contributions (see Cain, 2001b; Elkins,
2007; Wertz, 1998). For example, as a professor in a post-masters doctoral program, I
have found that most incoming doctoral students are unfamiliar with the research on
client-centered therapy, cannot articulate Rogers’s theory of personality, and are not even
aware that he had a developmental theory. Even more disturbing, many clinical
professors know little about Rogers and often hold stereotypical and misinformed views
about his contributions (see Elkins, in press-b). Clearly, something is wrong when one of
the most important clinicians in history is ignored in clinical training. Keep in mind that
I am not suggesting that Rogers’s ideas should dominate clinical training. I am merely
suggesting that they should be included and given their proper due. The fact that they are
not raises serious questions about the politics of clinical training in America.

Thus, the question addressed in this chapter is: Why do so many contemporary
clinical psychologists and training programs in clinical psychology marginalize or ignore
Rogers and his ideas? I realize that some would answer this question by saying that
Rogers is now out of date or that any substantial contributions he made have already been
incorporated into clinical psychology. I would suggest, however, that such answers
represent further dismissals of Rogers – the very problem this chapter
addresses -- and reveal a serious failure to grasp the nature and extent of his
contributions. Thus, in this chapter I will suggest a very different answer as to why
Rogers is ignored, one based on an examination of the politics of clinical psychology.


Carl Rogers and the Psychiatric Profession of the 1940s
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Before addressing the question directly, I would like to provide some relevant
historical information. Carl Rogers (1902-1987) received his Ph.D. in psychology from
Columbia University in 1931 and spent his early professional years working in child
guidance clinics. Originally, clinical psychologists had been associated primarily with
intelligence and personality testing but by the time Rogers came along in the late 1920s
and 1930s some had begun to do “counseling” or “guidance.” However, the “more
serious” work of psychotherapy was still the domain of psychiatrists. Psychiatrists
considered themselves the only ones capable of diagnosing and treating mental pathology
because (a) they were physicians and (b) they had been trained in the complex and
somewhat mysterious techniques of psychoanalysis. Psychiatrists were at the top of the
professional hierarchy and psychologists, social workers, and psychiatric nurses were
little more than “handmaidens” to psychiatrists. In short, psychiatrists held the power in
the “mental health” field.

They also held the power in psychotherapy. Psychiatrists were the “experts”
who “diagnosed” and “administered treatments” to “patients.” In keeping with the
medical model, the patient’s job was to provide information and follow the doctor’s
orders. The doctor’s job was to analyze the patient’s material and make interpretations so
that, in time, patients might gain insight into their own unconscious dynamics. Thus, as
physician and trained analyst, the psychiatrist was “in charge” of the therapeutic
relationship.

This was the historical stage onto which Carl Rogers walked in the early 1940s
with his “non-directive” approach, as his theory was then called. Based on his research
and clinical experience, Rogers had come to the conclusion that most clients are capable
of arriving at their own insights and solving their own problems. He believed therapy
was more successful when the counselor did not analyze, interpret, direct, control, or give
advice but, instead, focused on the client’s process and accepted, recognized, and helped
clarify the client’s feelings (see Bozarth et.al., 2001; Cain, 2001a; Rogers, 1942). In
short, Rogers rejected the therapist-centered model of therapy and articulated a new
client-centered approach.

Rogers’s views created an immediate uproar in the professional community,
especially among psychiatrists. The idea that patients could solve their own problems
without a psychotherapist to direct the therapy and to analyze and interpret the client’s
material was considered both naïve and dangerous. Even as late as 1951, at the
prestigious Menninger Clinic, Rogers was told that his brand of therapy would create
psychopaths (Rogers, 1977).

Rogers was puzzled by the negative reactions and wondered why his ideas were
so upsetting. He assumed it was because the ideas were new and had come from a
psychologist, not a psychiatrist. However, in the later years of his life Rogers came
across a concept that illumined these early experiences. In fact, the concept had such a
profound impact on Rogers that it caused him to reassess all of his professional work.
The concept was “the politics of interpersonal relationships.” Rogers (1977) described
how he was first exposed to this concept:


Three years ago I was asked about the politics of the client-centered approach


to psychotherapy. I replied that there was no politics in client-centered therapy,


an answer which was greeted with a loud guffaw. When I asked my questioner

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to explain, he replied, “I spent three years of graduate school learning to be an

expert in clinical psychology. I learned to make accurate diagnostic judgments.

I learned the various techniques of altering the subject’s attitude and behavior.

I learned subtle modes of manipulation, under the labels of interpretation and


guidance. Then I began to read your material, which upset everything I had


learned. You were saying that the power rests not in my mind but in his
organism. You
completely reversed the relationship of power and control which had
been built up in me over


three years. And then you say there is no politics in the client-centered
approach!” (p. 3)


At the time of this exchange, Rogers was unfamiliar with the word “politics” as
a term to describe interpersonal relationships. Later, Rogers (1977) wrote,


The use of the word “politics” in such contexts as “the politics of the family,”


“the politics of therapy,” “sexual politics,” “the politics of experience” is new. I

have not found any dictionary definition that even suggests the way in which


the word is currently utilized…. . Politics, in present-day psychological and


social usage, has to do with power and control: with the extent to which
persons


desire, attempt to obtain, possess, share, or surrender power and control over
others

and/or themselves. (p. 4)


This new concept gave Rogers a way to understand why his ideas had created
such furor in the 1940s. Rogers (1977) said,


It has taken me years to recognize that the violent opposition to a client-
centered

therapy sprang not only from its newness, and the fact that it came


from a psychologist rather than a psychiatrist, but primarily because it struck


such an outrageous blow to the therapist’s power. It was in its politics that it


was most threatening. (pp. 16-17)

A few pages earlier, Rogers (1977) had said,


I see now that I had dealt a double-edged political blow. I had said that most
counselors

saw themselves as competent to control the lives of their clients. And I had
advanced the view


that it was preferable simply to free the client to become an independent, self-
directing person.

I was making it clear that if they agreed with me, it would mean the

complete disruption and


reversal of their personal control in their counseling relationships. (pp. 6 -7)


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Rogers’s client-centered views turned the “politics” of psychotherapy upside
down. Rogers had said that the client – not the therapist – was the expert on the client’s
problems. The client – not the therapist – had the ability to solve those problems. The
client – not the therapist – held the power. Without fully realizing it at the time, Rogers
had asked psychiatrists to give up their role as the “all-knowing doctor” and to focus,
instead, on creating a therapeutic relationship characterized by empathy and acceptance
that would free clients to grow and thus become capable of solving their own problems.
In a sense, Rogers had asked psychiatrists to become “servants” to the client’s process.*
Clearly, in terms of the “politics of power,” Rogers had hit psychiatrists where it hurt.

*(Note from author: It’s worth mentioning that, etymologically, the word “therapist”
means “attendant” or “servant”).

Carl Rogers and Contemporary Clinical Psychology

But what does this history have to do with the question of why Rogers is
ignored by contemporary clinical psychology? I would suggest that, in large measure,
Rogers is ignored today for the same reasons he was attacked by psychiatrists in the
1940s: his client-centered views represent a threat to contemporary clinical psychology
just as they represented a threat to the psychiatric community in the 1940s. To adapt a
campaign slogan, “It’s the politics, Stupid.”

Contemporary clinical psychology is committed to the medical model -- the
same model that dominated psychiatry in the 1940s. Most clinical psychologists view
themselves as “doctors” who “diagnose” “mental disorders” and “administer treatments”
to “patients.” Thus, Rogers’s view that psychotherapy is not a set of medical-like
procedures but, rather, an interpersonal process that frees clients to grow and actualize
their potentials is a threat to contemporary clinical psychology just as it was a threat to
the psychiatric community 70 years ago. If clinical psychologists adopted Rogers’s
views, they would have to give up their role as “doctors” and the power this gives them
over clients, along with their belief that their medical-like techniques are responsible for
therapeutic effectiveness. Further, they would have to
focus their therapeutic efforts on creating an empathic, accepting, and open relationship
in which their clients could grow, discover their own insights, and find their own
directions. For those who view themselves as “doctors” who “administer treatments,”
this is not easy to do. Even for those who are not invested in power and who are, in fact,
drawn to Rogers’s ideas, it is difficult to embrace and practice client-centered values.
Our profession is so dominated by the medical model that in many clinical settings one’s
professional competence is judged by one’s ability to speak medical jargon and to
describe what one does in medical model terms. Also, adherents of the medical model
tend to receive the professional and economic rewards (e.g., better jobs, promotions,
salaries) that come to those who collaborate with the system. Thus, the politics of
clinical psychology, including its medical model ideology and system of professional and
economic rewards, makes it difficult for clinical psychologists to embrace Rogers’s views
even if they are inclined to do so. (For a more detailed critique of the medical model,
see Elkins, in
press-a).
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And what about clinical training? Why do so many programs marginalize or
ignore Rogers and his ideas? Again, I would suggest that, in large measure, it’s the
“politics.” Most training programs in clinical psychology, like the rest of the profession,
are immersed in the medical model. The academic courses and supervised training are
designed to produce “doctors” who can “diagnose” “mental disorders” and “administer
treatments” to “patients.” Rogers’s views simply do not fit in such programs. In fact, if
his views were taken seriously, they would undermine the ideology and goals of these
programs, not to mention how much they would upset professors who teach courses
based on medical model assumptions. Also, imagine what would happen if a significant
number of students were drawn to Rogers and his ideas. Suppose they said, “This is what
we always thought psychotherapy should be.” Clearly, this could create a serious morale
problem, leading students to challenge their professors and to question the validity of
their training experiences. Thus, in terms of the politics of power, it is in the best interest
of most training programs in clinical psychology to ignore Rogers as much as possible.

Insights from the field of critical psychology are relevant here. Critical
psychology, which began in Germany in 1970, is now a substantial movement (see Fox
and Prilleltensky, 1997; Prilleltensky and Nelson, 2005; Slife, Reber, & Richardson,
2005). Critical psychologists are committed to social justice and examine, among other
things, how psychology may collude, wittingly or unwittingly, with social and political
forces that are harmful to human beings. For example, critical psychologists have raised
concerns about clinical psychology’s tendency to focus on individual pathology while
ignoring the larger social forces that produce that pathology. Another issue they address
-- more directly related to this article -- is how and why psychology sanctions some
points of view but ignores or resists others. The term “gate- keepers” has been used to
refer to those who exercise power in determining which ideas are “allowed in” and which
are not. For example, influential psychology organizations such as the APA and editors
of major psychology journals exercise considerable power in determining which ideas
receive attention and which do not. Perhaps the most powerful gate-keepers, however,
are training programs in clinical psychology. Because everyone who wishes to become a
clinical psychologist must pass through their gates, training programs have enormous
power to shape students’ views of the profession and to indoctrinate them into whatever
happens to be the dominant ideology of the profession. Because training programs want
to retain their APA accreditation, be viewed positively by the professional community,
and ensure that their students are able to function effectively in the “real world” of
clinical psychology, they are motivated to provide conventional training so their students
can secure conventional internships which will prepare them for conventional jobs in
conventional settings. Thus, training programs have political and economic reasons to
reflect the dominant ideology of the profession and to marginalize ideas that are not
congruent with that ideology. As an example of how outside forces can affect clinical
training, consider how quickly some programs reinvented themselves in the 1980s and
1990s to reflect managed care’s emphasis on short-term therapies and “empirically
supported treatments.” The danger in allowing marketplace and other external forces to
shape clinical training is that science and good critical thinking may be trumped by
political and economic considerations. Indeed, scientific findings have now raised
serious questions about the overly zealous claims made by adherents of short-term
therapies and so-called “empirically supported treatments” (see Elkins, 2007, 2008;
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Hubble, Duncan, & Miller, 1999; Miller, 1994, 1996a, 1996b, 1996c; Seligman, 1995;
Wampold, 2001,).

I am not suggesting that those in charge of clinical training programs lie awake
at night trying to
think of ways to marginalize Carl Rogers. Instead, I am suggesting that training
programs are caught in a
web of political and economic forces that influence which ideas are considered
acceptable and which are resisted. Thus, training programs can become centers of
orthodoxy, dedicated to reflecting the status quo, instead of centers of creative and
critical thinking that welcome alternative and innovative ideas. This political perspective
makes it easier to understand why Rogers, one of the most important clinicians in history,
is ignored. He is ignored because his ideas are inconsistent with, and represent a serious
threat to, the medical model ideology that dominates contemporary clinical training and
practice.

Rogers’s Contributions and Their Political Implications

After his controversial debut in the 1940s, Rogers went on to become a leading
figure in American psychology. Research on client-centered therapy and the studies it
inspired literally dominated psychotherapy research for more than 20 years – from the
early 1940s through the early 1960s (Bozarth, Zimring, & Tausch, 2001). Eventually,
hundreds of students, psychologists, counselors, social workers, family therapists, group
therapists, and even a few psychiatrists embraced client-centered values. They were
drawn to Rogers’s view that clients have an innate ability to actualize their potentials and
that certain therapeutic conditions release this actualizing tendency. While it is not the
purpose of this article to discuss all of Rogers’s contributions, it does seem important to
highlight those that have political implications and are thus in line with the focus of this
article. Three overlapping contributions and their political implications are discussed
below.

Contextual Factors as the Effective Ingredients in Psychotherapy

During his tenure at the University of Chicago in the late 1940s and 1950s,
Rogers came to believe that the “conditions” he had discovered in client-centered therapy
(i.e., empathy, unconditional positive regard, and congruence) were the healing factors in
all therapeutic systems (Rogers, 1957, 1959). Thus, the research moved beyond an
exclusive focus on client-centered therapy and turned to the study of these conditions in
other therapeutic approaches. Although we now know that “contextual factors” include
more than Rogers’s three conditions, contemporary research on contextual factors (e.g.,
Wampold, 2001) makes it clear that Rogers was on the right track to reject the medical
model with its emphasis on techniques and to focus, instead, on other factors in the
therapeutic situation as the effective ingredients in psychotherapy. This contribution of
Rogers has political implications because, like the recent research on contextual factors, it
represents a frontal attack on the medical model and its focus on techniques as the
determinants of therapeutic outcome.

Rogers’s Theory of Interpersonal Relationships
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During the 1950s Rogers and his associates broadened the focus of their
research beyond psychotherapy to include other interpersonal relationships such as
parent-child, teacher-student, and employer-employee (see Gordon, 1970; Montuori &.
Purser, 2001; Thomas, 2001). As research findings came in, it became increasingly clear
that Rogers had discovered a simple formula with revolutionary potential to transform
human relationships: if those in positions of authority are willing to relinquish their
power over others and create an interpersonal milieu characterized by empathy, respect,
and congruence, amazing things are likely to happen. When individuals realize that they
are free to exercise their own power and develop their own potentials, they tend to come
alive and to grow in unpredictable but deeply meaningful ways. This new theory had
powerful political implications because it challenged authoritarian and paternalistic
models of human relationships and supported the power of children, students, employees,
women, ethnic minorities, and others whom society has often consigned to subordinate
positions in terms of power.

A New Theory of Power

Early on, Rogers’s research and clinical experience caused him to reject
therapist-centered approaches that focused on guiding, advising, suggesting, and
persuading clients. His subsequent research confirmed that clients tend to move in
positive therapeutic directions when therapists relinquish their control and support the
power of the client. From a historical perspective, Rogers was challenging the
authoritarian and paternalistic view of the therapeutic relationship that had originated
with Freud in the
Victorian Age. This is the same view of human relationships that once led our society to
believe that
husbands should have power over wives, that whites should dominate blacks, that
missionaries should “Christianize” traditional cultures, and that the U.S. government
should “civilize” Native Americans. It does not matter that there may have been some
good husbands, whites, missionaries, and government agents. It is also irrelevant that
some of the oppressed may have liked, loved, befriended, or collaborated with their
oppressors. What made these systems inherently flawed and irredeemably immoral was
their “politics” – the authoritarian and paternalistic assumption that certain groups know
what is best for others and therefore have a right to exercise power over them. Such
systems not only violate basic human rights but they also limit or destroy the unique
potentials of those who are oppressed. Authoritarian and paternalistic systems –
including therapy administered by experts who think they know what is best for others --
are far more dangerous than we have been led to believe.

Psychotherapy is highly political in the sense that it wields enormous power in
clients’ lives. In therapy, clients make decisions that change their lives forever; they set
sail on existential journeys of no return. Thus, how we as therapists deal with the power
inherent in psychotherapy is vitally important. As Rogers recognized, there are two basic
choices: we can assume the role of “expert” and tell clients how to solve their problems
and live their lives or we can adopt an emancipatory approach that supports clients’
power and frees them to make their own decisions, solve their own problems, find their
own directions, and become more fully who they are. As Rogers (1942) put it,

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Therapy is not a matter of doing something to the individual or of inducing him


to do something about himself. It is instead a matter of freeing him for normal


growth and development, of removing obstacles so that he can again move
forward. (pp. 28-29)

Referring to Gertrude Stein’s famous statement about the city of Paris, “It is not what
Paris gives you but what she does not take away,” Rogers (1977) said, “This can be
paraphrased to become a definition of the person-centered approach…. ‘It is not that this
approach gives power to the person; it never takes it away’” (p. xii).

This contribution has political implications because it challenges therapists to
abandon paternalistic approaches that disempower and to embrace emancipatory
approaches that set clients free. It is difficult to imagine how one can truly respect the
power of clients while relating to them as a “doctor” who “diagnoses” their “pathology”
and “administers treatments” to “cure” their “mental disorders.” We have become so
accustomed to such medical model language that we often fail to see just how patronizing
and disempowering it is. In contrast, Rogers’s approach to therapy, along with other
emancipatory approaches, supports the client’s power and adamantly refuses to take it
away. (For an excellent discussion of emancipatory therapy, see O’Hara, 2001).

Concluding Thoughts: Where We Are Today

Despite Rogers’s research which showed that interpersonal factors – not
techniques -- were the effective ingredients in psychotherapy, clinical psychology made a
radical turn in the 1970s toward investigations of “specificity,” i.e., specific treatments
for specific disorders (see Bozarth, et al., 2001; Bergin, 1997). Why this change occurred
is not clear but it certainly was not based on previous research findings. Most likely, it
represented a resurgence of the medical model in the vacuum created when Rogers and
his associates completed their last major research project in the 1960s (see Rogers,
Gendlin, Kieseler, & Truax, 1967). Also, many researchers and clinicians, perhaps
because of their “hard science” training, have difficulty believing that something as
“soft” as relational factors can be responsible for therapeutic effectiveness, even though
the research has confirmed this again and again. Whatever the reasons, the research
tradition that Rogers had originated and that had dominated clinical research for more
than two decades went into eclipse in the United States in the 1970s, and for the next 25
years (from the mid-1970s to the late 1990s) specificity research took center stage,
bolstered in the 1980s and 1990s by the rise of managed care with its medical model
assumptions about psychotherapy and its insistence that clinical psychologists
demonstrate the scientific validity of their techniques (see Bozarth et al., 2001, Elkins,
2007).

Today, however, something new is happening. After 25 years of specificity
research that involved hundreds of efficacy studies and millions of research dollars,
clinical researchers have failed to
demonstrate that any particular technique is any more effective than any other technique
(Ahn & Wampold, 2001; Elkins, 2007; Messer & Wampold, 2000; Wampold, 1997,
2001, 2005). Equally dramatic, recent analyses and meta-analyses of thousands of
research studies conducted over several decades have made it clear that contextual factors
– not techniques – are the primary determinants of therapeutic outcome (see Asay &
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