The Dodo Bird 1

Running Head: A CONVERSATION WITH SAUL ROSENZWEIG

Duncan, B. (2002). The founder of common factors: A conversation with

Saul Rosenzweig. Journal of Psychotherapy Integration, 12, 10-31.

The Founder of Common Factors:

A Conversation with Saul Rosenzweig

Barry L. Duncan

Institute for the Study of Therapeutic Change

The author is indebted to Dr. Saul Rosenzweig for his cheerful

participation and hospitality. The author also thanks Jacqueline Sparks

for her invaluable comments on this paper, and Tracy Mullendore and

Roberto Quiroz for transcription and library assistance.

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Abstract

In preparation for a commentary on Rosenzweig’s classic 1936 paper,

“Some Implicit Common Factors in Diverse Forms of Psychotherapy,” an

amazing discovery was made: Saul Rosenzweig is not only alive, but also

still contributing to science and society at age 93. This article sets

the stage for a conversation with the incredibly prolific Dr.

Rosenzweig by tracing the impact of his seminal contribution on early

common factors theorists. This review reveals Rosenzweig’s

unrecognized, but profound influence upon leading figures of not only

common factors, but also of psychotherapy itself. A conversation with

Dr. Saul Rosenzweig, the founder of common factors, is presented. This

noted scholar and wise elder of psychology reflects on the evolution of

his thinking from common factors to idiodynamics, and on topics ranging

from his passion for literature to his 1965 Buick Skylark, from the

history of psychotherapy to falling in love with ideas.

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The Founder of Common Factors:

A Conversation with Saul Rosenzweig

There is no new thing under the sun.

Bible, Ecclesiastes 1:9

A literature search in preparation for a commentary (Duncan, this

issue) on Saul Rosenzweig’s classic article, “Some Implicit Common

Factors in Diverse Methods of Psychotherapy” uncovered puzzling

findings. After the 1936 article, there seemed to be a great void--

nothing from Rosenzweig in follow-up to his incredibly prophetic

article and not much of anything else about common factors until the

middle 50’s. Trying to make sense of the nearly 20 year hiatus as well

as the surprising lack of reference to Rosenzweig’s contribution by

early common factor theorists, I pursued information about Rosenzweig’s

career to find some explanation.

A search on the internet revealed a shocking discovery: a Saul

Rosenzweig website, depicting not only a distinguished career, but also

an address and phone number! Could he still be alive some 65 years

later? I hurriedly called the number and amidst my fumbling and

excitement, Saul Rosenzweig, the founder of the common factors

movement, answered the phone. He is alive, vibrant, and still

contributing to science and society at age 93. Although delighted,

imagine my embarrassment. My colleagues and I dedicated our edited text

about common factors to him (Hubble, Duncan, & Miller, 1999) to honor

his status as the original common factors theorist. We, of course,

assumed him dead. How wrong one can be.

He wrote the first known proposal for common factors at the ripe

old age of 29 (see appendix 1 for a brief biography). This 1932 Harvard

Ph.D. and schoolmate of B.F. Skinner and Jerome Frank, did indeed

follow up on common factors: a 1938 article and 1940 panel presentation

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elaborated and further disseminated his common factors argument; a

related 1937 article, building on the commonality among approaches,

cogently addressed their inherent complementarity. Thereafter, the idea

of complementarity evolved into his life’s work and greatest passion,

idiodynamics, creativity, and personality theory. Rosenzweig’s prolific

and meaningful career, some 223 publications, and counting, spanned

many other areas as well: empirical psychodynamics, projective

assessment, frustration and aggression, historical psychology, to

mention a few (visit http://artsci.wustl.edu/~srosenzw/SRBIB.html for a

comprehensive list of Dr. Rosenzweig’s publications). Rosenzweig is

well known to many in surprisingly varied contexts within psychology:

for his correspondence with Freud; for his contributions to projective

assessment (The Picture-Frustration Study); for his oft cited response

to Hans Eysenck’s (1952) critique of psychotherapy (Rosenzweig, 1954),

and his New York Times acclaimed analyses of Freud’s visit to the

United States (Rosenzweig, 1992). But there is much more.

Although the 1936 article was honored by reprinting in Goldfried

(1982), it seemed only recently that Rosenzweig’s path cutting

perspective has begun to be appreciated (see Weinberger, 1993).

Luborsky (1995) honors Rosenzweig, saying that the 1936 paper “deserves

a laurel in recognition of its being the first systematic presentation

of the idea that common factors across diverse forms of psychotherapy

are so omnipresent that comparative treatment studies should show

nonsignificant differences in outcomes” (p. 106). On closer inspection,

however, Rosenzweig’s influence regarding common factors can be found

in many places, most notably on those who are often credited by later

common factors theorists.

This article briefly compares Rosenzweig’s seminal contribution

with early common factors publications so that the reader may

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appreciate its powerful impact. With that context set, a conversation

with Dr. Saul Rosenzweig, the founder of common factors, is presented.

This noted scholar and wise elder of psychology reflects on the

evolution of his thinking from common factors to idiodynamics, and on

topics ranging from his passion for literature to his 1965 Buick

Skylark, from the history of psychotherapy to falling in love with

ideas.

In The Beginning: The Birth of Common Factors

In 1936, writing in the American Journal of Orthopsychiatry,

Rosenzweig observed that no form of psychotherapy or healing is without

cures to its credit. Concluding that success is therefore not a

reliable guide to the validity of a theory, he suggested that some

potent implicit common factors, perhaps more important than the methods

purposely employed, explained the uniformity of success of seemingly

diverse methods. Rosenzweig summarized these common factors:

…the operation of implicit, unverbalized factors, such as

catharsis, and the yet undefined effect of the personality of the

good therapist; the formal consistency of the therapeutic

ideology as a basis for reintegration; the alternative

formulation of psychological events and the interdependence of

personality organization (p. 415).

The following review traces these original ideas in arguably the

most influential of the common factors theorists. Comments concerning

whether Rosenzweig’s 1936 proposal was referenced by different authors

are offered only for reader reflection on the historical significance

of that classic article. These comments are in no way meant as a

criticism of scholarship nor intended to imply in any way whatsoever

that Rosenzweig’s ideas were used without proper credit.

Common Factors: A Brief Review

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An altogether forgotten panel (notable exceptions: Goldfried &

Newman, 1992; Sollod, 1981; Weinberger, 1993), assembled several

prominent theorists at the 1940 conference of the American

Orthopsychiatric Society. This presentation, the “Areas of Agreement in

Psychotherapy,” was later published in the American Journal of

Orthopsychiatry (Watson, 1940). The panelists agreed that more

similarities existed between approaches than differences, and

articulated four areas of agreement (objectives are similar, the

relationship is central, keeping the responsibility for choice on the

client, and enlarging the client’s understanding of self). Watson, in

his conclusion, also said:

…if we were to apply to our colleagues the distinction, so

important with patients, between what they tell us and what they do, we

might find that agreement is greater in practice than in theory…We have

agreed further…that our techniques cannot be uniform and rigid, but

vary with the age, problems and potentialities of the individual client

and with the unique personality of the therapist…A therapist has

nothing to offer but himself (p. 29).

Although these points alone make the article well worth the read

for integrationists, who participated in that presentation is even more

compelling. Saul Rosenzweig outlined his implicit common factors with

some further elaboration, and Carl Rogers, yes, Carl Rogers, presented

about areas of agreement in working with children. Rogers highlights

this panel as recommended reading in his first book, Counseling and

Psychotherapy (1942), and also references Rosenzweig’s 1936 paper. It

is difficult to say how much Rosenzweig’s ideas regarding the qualities

of a good therapist influenced Rogers, but Rogers did often cite

Rosenzweig’s work. Sollod (1981) also notes that the 1940 panel

significantly influenced Rogers, especially the ideas offered by

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Watson. Rosenzweig was later invited by Rogers to present to Rogers’

colleagues in Chicago (see below).

Not much else was said about common factors until an interesting

study by Heine (1953) foreshadowed later comparative investigations.

Heine credits the questions raised by Rosenzweig as providing the

impetus to conduct a study that compared several of the prevailing

methods of the day. Given comparable results, Heine supported

Rosenzweig’s analysis by concluding that a common factor(s) was

operating in the different forms of psychotherapy investigated. Heine

suggested that theory and technique are less important than the

characteristics of the individual applying them—a conclusion that

reiterates the 1940 panel’s assertions and has since gained much

empirical support. He recommended that the field devote itself to

developing a psychotherapy rather than a variety of psychotherapies.

Heine’s influential study was often referenced by later scholars, as

noted below. Heine was also acknowledged in Fiedler’s (1950) classic

investigation of the ideal therapeutic relationship.

Nineteen years after the original article, Paul Hoch echoed

Rosenzweig’s words, without reference, in a 1955 article:

…if we have the opportunity to watch many patients treated by

many different therapists using different techniques, we are

struck by the divergencies in theory and in practical application

and similarity in therapeutic results…. There are only two

logical conclusions…first that the different methods regardless

of their theoretical background are equally effective, and that

theoretical formulations are not as important as some unclear

common factors present in all such therapies (p. 323).

Rosenzweig said:
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What…accounts for the result that apparently diverse forms of

psychotherapy prove successful in similar cases? Or if they are

only apparently diverse, what do these therapies actually have in

common that makes them equally successful?…it is justifiable to

wonder…whether the factors that actually are in operation in

several different therapies may not have much more in common than

have the factors alleged to be operating (p. 412-413).

Hoch posited two common factors: the establishment of rapport and

trying to influence the patient. He articulated six methods of

influence (reassurance, catharsis, interpretation, manipulating

interpersonal relationships, and altering environmental forces).

In 1957, Sol Garfield, noted common factors theorist and

significant contributor to the advancement of a common factors

perspective, included a ten-page discussion of common factors in his

book, Introductory Clinical Psychology. He identified a number of

features common to psychotherapy including a sympathetic nonmoralizing

healer, the emotional and supporting relationship, catharsis, and the

opportunity to gain some understanding of one’s problems. Several of

Rosenzweig’s articles are referenced in this text, but his common

factors article is not. Garfield (1992) does reference Rosenzweig’s

1936 article in a discussion of his own evolution to a common factors

perspective, but credits Heine (1953) and Rogers (1942) for the

inspiration of his ideas. Heine and Rogers, as noted, were

significantly influenced by Rosenzweig.

The same year, 1957, Rogers published the profoundly influential

paper, “The Necessary and Sufficient Conditions of Therapeutic

Personality Change,” in the Journal of Consulting Psychology. That

article did not reference Rosenzweig. Given the impact of Rogers’ 1957

article, his participation on the 1940 panel and association with

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Rosenzweig looms large as an unnoticed, but perhaps dramatic event in

the development of psychotherapy. Speaking of the relationship,

Rosenzweig makes an interesting comment in his 1936 paper regarding

“the indefinable effect of the therapist’s personality.”

. ...observers seem intuitively to sense the characteristics of

the good therapist time and again…sometimes being so impressed as

almost to believe that the personality of the therapist would be

sufficient [emphasis added] in itself, apart everything else, to

account for the cure of many a patient by a sort of catalytic

effect. (p. 413).

Although the recognition of the importance of the therapeutic

relationship was widespread as early as 1940 (see Watson, 1940), this

may be the first report of the “sufficient” nature of the therapist

provided variables as popularized by Rogers’ groundbreaking 1957

article.

If Rosenzweig wrote the first notes of the call to the common

factors, Johns Hopkins University’s Jerome Frank composed an entire

symphony. Frank’s (1961) book, Persuasion and Healing, was the first

entirely devoted to the commonalities cutting across approaches. He

incorporates much of Rosenzweig’s brief proposal, but articulates a far

more expanded theoretical and empirical context, especially regarding

the profound effects of expectation and placebo in healing endeavors.

In this and later editions (1973; 1991), Frank placed therapy within

the larger family of projects designed to bring about healing. He

(joined by his daughter, Julia, in the last edition) looked for the

threads linking such different activities as traditional psychotherapy,

group and family therapies, inpatient treatment, drug therapy,

medicine, religiomagical healing in nonindustrialized societies, cults,

and revivals. Interestingly, Rosenzweig notes (see below) that his

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historical research of healing in religious and supernatural contexts

as a precursor to psychotherapy also fueled his ideas about common

factors.

In his analysis, Frank (1973) concluded, that therapy in its

various forms should be thought of as “a single entity.” He proposed:

. . . two apparently very different psychotherapies, such as

psychoanalysis and systematic desensitization, might be analogous

to penicillin and digitalis--totally different pharmacological

agents suitable for totally different conditions. On the other

hand, the active ingredient of both may be the same, analogous to

two compounds marketed under different names, both of which

contain aspirin. I believe the second alternative is closer to

the mark (p. 313-314).

Frank also identified four features shared by all effective therapies:

(a) an emotionally charged, confiding relationship with a helping

person, (b) a healing setting, (c) a rationale, conceptual scheme

or myth that provides a plausible explanation for the patient’s

symptoms and prescribes a ritual or procedure for resolving them, and

(d) a ritual or procedure that requires the active participation of

both patient and therapist and that is believed by both to be the means

of restoring the patient’s health.

Although Frank’s common factors bear a resemblance to

Rosenzweig’s original formulations, especially the notions of a

conceptual scheme and alternative explanation, and the therapeutic

relationship, he is not referenced until the 1991 edition. Frank does

reference both Rogers (1942) and Heine (1953) in the 1961 edition.

Frank’s “single entity” notion seems akin to Heine’s idea of developing

“a psychotherapy.” Curiously, both Garfield (1982) and Frank (1982)

contributed to Goldfried’s (1982) excellent book on common factors,

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Converging Themes in Psychotherapy, which reprints Rosenzweig’s 1936

paper, but neither reference him in that volume.

Picking up on Frank’s far reaching discussion of placebo, the 70’s

included related works from theorists who conceptualized the common

factors in terms of placebo effects (e.g., Shapiro, 1971; Shapiro &

Morris, 1978). The 70’s also ushered a more refined definition of the

basic ingredients of psychotherapy (e.g., Garfield, 1973; Strupp,

1973), an increased empirical argument for the common factors (e.g.,

Strupp & Hadley, 1979), and the empirical confirmation of yet another

Rosenzweig brainchild, the dodo bird verdict (Luborsky, Singer, &

Luborsky, 1975).

A Conversation with Saul Rosenzweig

The following conversation occurred at Dr. Rosenzweig’s office in

St. Louis on October 12, 2000. Segments of some of his papers are

intertwined in the conversation to provide the reader additional

context to understand our discussion. Our conversation began in the

living room of his office, migrated to the study, continued in a 1965

Buick Skylark, unfolded over lunch at the faculty restaurant at

Washington University, and concluded back in his study over wine and

nuts in the delightful company of his wife Louise and assistant, Amy

Hackney, a Ph.D candidate in social psychology at St. Louis University.

This conversation will hopefully allow the reader to discover and

appreciate, as I did, the many contributions of Saul Rosenzweig to

modern psychotherapy and integration.

Barry Duncan (BD): I am very pleased you consented to having me

come out here and talk with you. I must have sounded wacky when I

called you. Here I am working on this article about your work, and it

was just incredible to find out that...

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Saul Rosenzweig (SR): You thought I might have been in the other

world, huh?

BD: Yes, yes.

SR: Then you would have to get a soothsayer or something to

communicate with me.

BD: That’s right. (laughing) Well I have to admit something else

to you. I was writing the article as if I was interviewing you.

SR: You were interviewing me? Oh, I see.

BD: Yes.

SR: Well that’s very interesting.

BD: So here I was using you as a literary device and all along I

could have asked you these questions.

SR: How did you discover that I was still alive and going?

BD: I did a search on the web and found your website.

SR: Oh yes, I was on there, I have that website.

BD: Well I am so glad that you did, because I would have been

forever embarrassed about writing about you and not talking to you. So

you saved me from great academic embarrassment.

SR: That’s good. (laughing) Where do you want to start?

BD: There’s so much of interest about your career, and of course,

my interests are around common factors, so I would like to start there.

Who or what inspired you to think about or write about implicit common

factors? Did you have a professor, or someone that you had discussed

the ideas with?

SR: That’s a good place to start. Did you notice the wall hanging

there? I knew that I was going to show you that, but I didn’t realize

it was so relevant until now. I call it ‘the panorama of psychotherapy’

and I did that as a graduate student at Harvard Psychological Clinic in

approximately 1932, when I got my Ph.D. Degree, and thereafter when I

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became a research associate at the clinic with Dr. Henry Murray. You

know that name?

BD: Oh, yes.

SR: Well, he was my mentor at that time, my sponsor for my

dissertation. So, have you heard of Christiana Morgan?

BD: Yes.

SR: She was the one that really created the TAT. And, of course, it was

there that I became interested in the projective techniques, and I

studied frustration as part of my dissertation. And that interest

evolved into the Picture-Frustration Study, which is now used

worldwide. Most people know me by that test. I actually don’t like the

term ‘test.’ I call it ‘study’ because I think ‘test’ implies right and

wrong answers. Study is much more the way in which the projective

techniques work. They emphasize the experience of the individual.

That’s why I called it the Picture-Frustration Study. Part of my

inspiration for that came from Galton, who introduced word association.

Galton was one of the pioneers of psychology that I greatly admired. I

have all of the first editions of all of his books. Anyway, at the

Harvard Psychological Clinic, which started in 1927, I joined the

faculty, the staff there, as a research associate. Christiana Morgan

was an associate of the clinic, and as revealed later, she was really

Henry Murray’s mistress.

BD: Oh really?

SR: There’s a book about that. Do you know about that book?

BD: No.

SR: It’s called Love’s Story Told by Robinson and that is really the

biography of Henry Murray, and tells about their relationship. Then

there’s another book about her and that’s called, Translate This

Darkness, which refers to her being brunette. That’s the story of

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Christiana Morgan. She was a colleague of mine at the clinic and she

had a hand in this wall hanging. There are some red places in between

the pictures, red vermilion. She painted those vermilion red spots. I

had an interest in history and psychotherapy from the very beginning of

my career, and so that’s why I did it. It begins at the left of the top

row and goes this way, starting with the Hindu god of the mind, Indra,

resurrecting a young boy. And then there are symbols of the elements,

air, fire, water, and earth. That’s in between that picture and the

next one, which is the Zodiac man, painted by Brown in 1470, taken from

Garrison’s famous History of Medicine. I gathered all of these at the

library at Harvard, from the rare book room. Then I had the border,

which is redwood, imported from California. The carvings were put on

there by a wood burning set by an art student that I knew. At the

clinic, there was a patient in occupational therapy. His name was John.

He was the one who did the framing of those pictures in the glass. It

was really a collaborative work.

BD: Yes.

SR: I was architect, the designer of it, John did the framing of the

pictures and I did all the research of course, and Christiana Morgan

did the vermilions, and this young man whose name I have forgotten, did

the carvings. So as they say, the whole story is here and it goes on

from the Zodiac Man, which of course, was used as a way of guiding

medical people. They weren’t really medicine doctors, they were

astrologers, and so the Zodiac man was important to them. The third one

is the confessional, which is a form of therapy, but in the church.

Next is the temple of Aesculapius and the scene in Epidaurus.

Aesculapius was the god of health and medicine. People used to sleep in

this temple in Greece and they had dreams. And the priests would stay

in this temple while they would sleep and when they would wake, he
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would ask them about their dreams--a predecessor to Freud’s

interpretation of dreams. Then King Louis X, the fourth picture, of

France, applying the royal touch for the cure of diseases. The royal

touch was a very famous method, used not only by King Louis X of

France, but by others as well. And then there’s Jesus, the fifth one,

casting out devils. Keep in mind that I am interpreting all these

methods of healing as predecessors of psychotherapy. And then the next

one is the Egyptian goddess Isis and her son Horus. Isis restored her

son to health from a fatal disease. That one is from a book called,

Evil Eye. And then the last one at the top is of an American Indian, a

medicine man, in action. And that is from Whitebread’s Medical

Collection. Then as you continue, down at the bottom, at the left,

that’s a picture of Antoine Mesmer, the discoverer of hypnosis, or

animal magnetism. And that shows him with a subject at a séance, who

had been hypnotized or mesmerized. The people would sit around holding

hands, as well as objects that had been soaked in that magnetized

water, and were cured of illnesses, including of course, hysteria. Next

comes Pinel, the famous man of France, removing the chains from the

insane at the Bicetre. And the next one is the revolving chair for

treating the insane. Darwin and Cox invented this in the early 19th

century. Erasmus Darwin was the grandfather of Charles Darwin. This

comes from a book by Krepelin, called A Hundred Years of Psychiatry.

Darwin’s grandfather was a famous physiologist-poet, and in my own

library I have his book, Botanical Garden, which is a book about

medicine. And then the next is an amulet, for overcoming the evil eye,

and then a reproduction of Rembrandt’s painting of David playing before

Saul. The biblical story is that Saul was a man of moods and

melancholia and David played music, which soothed him. That was the

beginning of music therapy, which was used quite a bit in mental

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hospitals. And then the last one is of course, the etching by Max

Pollock of Freud from the Menorah Journal. Finally, there is the

symbolic serpent of the medical profession. So it’s very nice that I

can show this ‘panorama of psychotherapy’ to you because it is relevant

to our discussion today.

BD: How so?

SR: History is relevant to my interest in common factors. It was also

relevant that I actually did psychotherapy in the psychological clinic,

with Murray and Morgan. I had an office between Murray and Morgan. I

don’t know why they gave me such a special location. But the common

factors came out of my awareness that there was such a variety of

methods trying to reach the mind and doing mental tricks of various

kinds--like the evil eye, the royal touch, the revolving chair, and so

on and so forth. All seemed to have more in common, implicitly, than

not. All those precursors to psychotherapy from the panorama bear a

resemblance to each other and later forms of healing like

psychotherapy. And I don’t know of anyone that suggested that to me,

maybe I’ll remember later, I don’t at this point.

BD: But largely it arose from your interest in history. Through your

historical analysis of psychotherapy, you realized the common elements

of all forms of influence and healing. That’s interesting because Frank

used a similar cross-cultural perspective of healing in his discussion

of common factors.

SR: Yes, if I wasn’t interested in history I wouldn’t have arrived at

this. That certainly had a lot to do with it. That combined with my own

psychotherapy experiences of what seemed to matter.

BD: I am very curious about how you came up with the quote from Alice

in Wonderland? Everybody thinks that either Frank or Luborsky

originally invoked the dodo bird judgement, even though Luborsky says
 The Dodo Bird 17

in his article in the second line that you did. I hope this interview

finally clears this misconception.

SR: Yes, well, Luborsky called it the ‘dodo verdict.’ That’s what he

said, what he did invent. But it was taken from ‘Some Implicit Common

Factors.’

BD: How did you come up with that?

SR: Well, I used to read all sorts of literature. I am very interested

in literature and creativity, which we will get to a bit later. One of

the people I studied was Lewis Carroll.

BD: Oh.

SR: And Edward Lea, in fact, I have a very special collection of Edward

Lea’s first editions. Edward Lea and Lewis Carroll are the two founders

of children’s literature in England and, Lewis Carroll, of course,

wrote the famous Alice in Wonderland. He was actually a professor of

mathematics at Oxford and his real name was Charles Dodgson. And he

also wrote The Looking Glass, and Hunting of the Snark. I was very

interested in that literature. As a matter of fact, I have first

editions of those books. I have a very special collection of children’s

literature. So that’s how I knew that material inside and out, and the

race is one of the famous incidents in that story which seemed to

perfectly fit the state of affairs I was discussing in that article.

BD: Yes, it sure did. So the dodo bird came from your avid interest in

literature.

SR: Yes, oh yes. And specifically, my interest in literature evolved

from the psychology of creativity. I studied literature in terms of

creativity. In fact the foundation which I started a few years ago, the

Foundation of Idiodynamics, Personality Theory, and Literary Creativity

has grown from that interest. I have analyzed, via my idiodynamics, the
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work of the Henry James Sr. family, Dodgson, and even Freud. Because

Freud was a better writer than he was a psychologist.

BD: He was persuasive.

SR: Very persuasive and very ingenious, and not understood. I don’t

mean that he’s misunderstood, but that he’s just not understood…Well,

it’s time for lunch, but it is too late to call a cab, so I will drive.

I still drive, you know.

BD: I would be happy to drive, if you like.

SR: No one drives my car but me.

BD: Okay, sure… (Arriving at the car) Wow, this is a quite a car. My

son Jesse has a 69 Ford Falcon—he would love this. What year is it?

SR: It is a 1965 Buick Skylark. As cliched as it sounds, they don’t

make them like this anymore.

BD: Indeed they don’t… (Continuing interview) So, what I would like to

do at this point is start with the 1936 paper and follow the trail of

your thinking from there. I thought at first that the common factors

article just stood by itself, that you did nothing else with that

paper. But the more I investigated the more I saw that was a

misconception I had formed from only seeing the 1936 article referenced

in the common factors literature. That misconception is conveyed in our

common factors book and I will be sure to correct it in the second

edition.

SR: Oh sure, that’s natural, with a first edition. Happens all the

time. You always find new things after you have gone to print. I want

to emphasize that my thinking evolved from there--that 1936 article was

a start of a process that never stopped for me, that took me to many

different places.
 The Dodo Bird 19

BD: I will do my best to do so and you can look at this and make sure I

conveyed your process appropriately. So after the ’36 paper, what was

the reaction?

SR: Well, I’ll tell you a story that characterizes a lot of the

reaction: There was a psychiatrist that I worked with at Worcester

Hospital, Jacob Kasanin, and he walked in my office holding the issue

of the journal in his hand, and said only “Fools rush in where angels

fear to tread.” (Both laugh) I think he meant that it was controversial

to challenge the special validity that each psychotherapy believed it

held.

BD: It still is, if you can believe that.

SR: Not surprising, really.

BD: Next came the 1937 paper ‘Schools of Psychotherapy: A Complementary

Pattern.’ You seem to take a different angle but in the same direction.

SR: That’s right. ‘Implicit Common Factors’ spoke to the commonalities

that all approaches shared, and ‘Schools’ spoke to the

complementarities that existed among approaches. ‘Implicit Common

Factors’ also spoke to complementarities in some ways, especially in

the discussion of the many different types of interpretations from

differing orientations that can be ‘correct.’

BD: In the ‘Schools’ paper, you make a strong case for a relatively

simple underlying pattern of complementarity, based on each approach’s

specific representation of a problem, special methodology, and

preferential alliance with other sciences. You argue to ‘unite the

warring factions’ of psychology through their complementarity, and

render the disagreements among them as ‘arbitrary and unnecessary.’ Not

one to avoid controversy, you also said, “…schools have been committing

a ‘fallacy of arrogation,’ i.e., exploiting their concepts by unduly

subordinating to them phenomena for which they were not originally

 The Dodo Bird 20

intended and for which they are not really adequate.” You sound like an

integrationist! Those words could be in the mission statement of the

journal that this interview will appear in. That article has great

relevance to much of what is being said today. You picked up on some of

those ideas in the 1940 presentation, which we will get to a minute.

SR: Yes, exactly, all of my early articles stressed different types of

complementarity.

BD: Different types. Okay.

SR: Can we stay on this line of thought for a while?

BD: Sure.

SR: Those early articles were important and lead me to idiodynamics,

but I didn’t use that term until ’51. Actually the first form of

complementarity that I discussed was between experimenter and

experimentee (Rosenzwieg, 1933). The 1936 paper was the second type,

and the ‘Schools’ paper was yet another. The ‘Schools’ paper showed

that the division of labor among the five then-current schools

represented a complementary pattern in which a certain type of problem

achieved acceptable resolution by methods and concepts appropriate to

the problem emphasized. When I wrote that paper, Neals Bohr, the

Scandinavian physicist, was an inspiration regarding complementarity.

He introduced a similar way to solve seemingly irreconcilable theories

in physics. In 1927, the principle of complementarity was formulated as

an alternative to Heisenberg’s “indeterminacy,” and as a new way of

reconciling the conflicting conceptions of light as consisting of

waves, on one hand, or particles, on the other. To Bohr, both

formulations were justified and were equally correct once it was

recognized that each was served by a different observational approach.

When my 1937 paper appeared, interestingly Bohr was recommending that

complementarity be extended beyond the physical to the natural

 The Dodo Bird 21

sciences, including biology and psychology. So that notion of

complementarity was at the heart of my own thinking. That paper of

Bohrs not only appeared in the same year, but in the same journal as

mine did (The Journal of Philosophy)! And probably for that reason I

got a letter from Tolman, not the famous psychologist Edward Tolman,

but his brother, who was a physicist and dean of the California

Institute of Technology. And out of the blue one day, while I was still

at Worcester Hospital, I got a letter from him. In fact, I want to show

you that letter. (Shows BD the letter) He wrote that to me in ’37.

Richard was the brother of the famous Edward Tolman, and he makes that

joke there in the very beginning, you see? I just prize this letter…

Okay, back to common factors.

BD: Okay, how did the 1940 panel come together?

SR: Goodwin Watson organized it. I didn’t feel that it was a highly

successful meeting. I don’t know why I believe that, maybe because of

how it was presented or how I presented, but it certainly was on the

common factors topic.

BD: Watson was the chairperson, he wrote the summary at the end. That

panel is all but forgotten. You know that two of the three references I

found to it, Carl Rogers is not even mentioned, and in one of the

references, you are not mentioned. So how could that get by?

SR: Yes, yes. Things fall through the cracks often, only to resurface

later.

BD: So Alexandra Adler was one of the people.

SR: Oh yes, I remember her. She was, I think, the wife of, or at least

some relative, of Alfred Adler.

BD: Let’s see who else was on this. Frederick Allen.

SR: Frederick Allen was a Rankian. Rank was an important figure. Allen

was the director of the Philadelphia Child Guidance Clinic.

 The Dodo Bird 22

BD: You elaborated on some things that I found very interesting: the

importance of the faith of the client in the therapist and the method,

and the notion of fitness. You actually said in that outline that the

content of the interpretation or approach was secondary to the common

factors and that it actually had more to do with the fitness for a

specific patient. The idea of fitness is a very important idea in

integration.

SR: Yes, yes, and that actually was one of the conclusions of the

panel, about the uniqueness of the individual. I am very interested in

the uniqueness of the individual. Allport’s idea of uniqueness referred

mostly to traits. Idiodynamics stresses that it was not just a matter

of traits but also of the unique history, and the dynamic development

of the individual. So the fitness of the interpretation or method is

obviously of great importance, more so than its correctness.

BD: Do you recall your interactions with Carl Rogers? Rogers gives a

fair amount of emphasis to the impact of that panel on his thinking.

SR: Yes, I remember one time when I visited at his invitation, he was

in Chicago at the time and I gave a talk. I think at that time I was at

the Psychiatric Institute at the University of Pittsburgh. That must

have been like 1945. And he had a seminar group and he invited me to

talk on what I called ‘Understanding the Individual.’

BD: Rogers referenced you and the panel in his 1942 book, his first

book, and then he referenced you in later works as well, so I think

that your view of common factors were an influence on him, and perhaps

your interest in the individual reinforced his ideas as well.

SR: Oh yeah, he was interested in those ideas and really kept up with

the literature.

BD: I was wondering if there were any conversations that you remember

having with him about common factors.

 The Dodo Bird 23

SR: Well I don’t remember any specifically, but when I visited him in

Chicago there must have been. I can’t imagine that we didn’t talk about

that because of his interest in the ’36 paper and our collaboration in

the 1940 panel. That had a lot to do with my having been invited.

BD: Another interesting thing you said in that panel presentation was

about a ‘rapid course of treatment.’ Do you remember what was behind

that? No one ever talked about…

SR: That was before brief psychotherapy.

BD: Yes, quite a bit! It was like 1946, Alexander is the.

SR: Franz Alexander.

BD: Yes. So you moved on from there and laid more groundwork for

idiodynamics through your analysis of Murray, Allport, and Lewin, and

again with an emphasis on complementarity. You were always moving on to

new projects, taking your ideas to the next level, and expanding into

new areas, but continually weaving in complementarity, history, and

literature.

SR: Yes, that’s accurate. There actually was a couple of other common

factors works. A 1938 paper, ‘A Dynamic Interpretation of Psychotherapy

Oriented Towards Research’ published in Psychiatry: Journal of the

Biology and Pathology of Interpersonal Relations.

BD: (BD has since read that paper) In that paper you say, ‘When one is

thus prodded it requires but little reflection to realize that the

effective factors in any form of psychotherapy are not necessarily

those upon which its proponents insist. Unrecognized factors play a

part and among these there may be more that is common than different.’

You elaborate, like your 1940 panel presentation, more on the faith of

the client in the therapist and emphasize the importance of not only

recognizing common factors, but also researching them. Prophetic words

indeed.
 The Dodo Bird 24

SR: The other one is a book I put together called “Facets of

Psychotherapy” which brought my collected papers about common factors

together, as well as other ideas I had about psychotherapy. And I

actually have in my files, the manuscript that I submitted to Grune and

Stratton, the publisher. They had published my book, Psychodiagnosis,

in 1949, and that’s why they were interested in another book. I sent it

in and a few months later I decided that it wasn’t good enough and I

wanted to rewrite some portions. It went through various revisions and

title changes, but it ultimately died in committee so to speak.

BD: Well you went on to the next thing and didn’t want to go back.

SR: That’s it, that’s exactly it. To me, by the time I got to the next

thing, I saw the other as being over with.

BD: That book, ‘Facets of Psychotherapy,’ would have predated all the

famous books about common factors, like Jerome Frank’s, which came out

in ’61. Your ideas got picked up a couple of decades later, and then

people became very famous for picking up on them.

SR: Yes, yes. Well, that is the way it works. And I became very

interested in history and literature as a basis for idiodynamics. Let

me tell you about that. In this approach, the individual is considered

to be a universe of psychological events, what I call the ‘idioverse.’

The basic notion is that these events when viewed in their entirety

provide new insights at the phenomenological level that can later be

subjected to verification as actual historical or biographical facts. I

haven’t finished my publications on that. I am currently working on the

James family. I told you, upstairs, about the book I am working on

about Henry James. In his story, The Death of the Lion, he mentions the

larger latitude of the lion, which he never defines. It’s sort of a

special phrase, but unquestionably he means bisexuality. And so, that

is one way that I got out of the common factors, I became interested in
 The Dodo Bird 25

the creativity of these people. I have made an in depth study of Henry

James in particular, but have also studied the whole family and have

published a couple of papers on them. I have a special library on the

James family, all the first editions of Henry James, as well as William

James, the father, which are really pretty rare. Idiodynamics was

developed largely in terms of these literary figures, as well as Freud,

himself. I reread all of Freud and studied his dreams. There were about

24 in The Interpretation of Dreams, and each of those dreams is

analyzed on the basis of his own associations, but then carrying on

from where he left off. Freud refers to the same dream in a number of

places in the book. So I put together all of these in one section. Each

of these dreams I studied as a project by itself, using idiodynamics.

And so he was one of the figures. But I also did this with the James,

Henry James especially, Hawthorne, and Melville. I made a number of

new, call them ‘discoveries’ if you will, but a new understanding.

A relationship between Hawthorne and Melville grew out of their meeting

in the Berkshires in 1850-51, where they were together for about a

year. And at that time, each one wrote their masterpiece. Moby Dick was

written at that time by Melville and Hawthorne was working on The House

of Seven Gables, which was his favorite book. And both of those books

grew out of the same sources which I have traced. So I am working on a

book about their association, when they were at ‘the zenith,’ which I

call it--the height of their creativity and when they produced their

best work. Later Hawthorne got involved, because of a need to make a

living, with Franklin Pierce, the president. He was a very unpopular

president but he gave Hawthorne a well paying job that Hawthorne needed

badly. Melville died in obscurity, he was a customs officer in the port

of New York, and he died there completely unknown, and unrecognized. He

is buried in the Bronx. In my studies, I visited that grave by the way,

 The Dodo Bird 26

as well as Hawthorne’s grave at Sleepy Hollow in Concord, and Freud’s

at Golders Green Crematorium in London. At any rate I have studied

these authors, including Freud himself, from the point of view of

idiodynamics… (Break for wine and nuts with Mrs. Louise Rosenzweig and

Ms. Amy Hackney)

BD: So one thing that I am painting here, and I realize that it’s me

doing the painting, is that all the common factors roads lead back to

you in some way or another. I don’t know if you are familiar with the

trivia game about Kevin Bacon, the actor. This is kind of silly, so

bear with me. The game is called ‘6 degrees of Kevin Bacon.’ The theme

of the game is to trace any actor to a movie with Kevin Bacon within 6

connections. For example, the actress Joan Allen, in the movie, ‘The

Contender.’ Also in the same movie is Christian Slater, who was in

‘Murder in the First’ with Kevin Bacon. The theory is that Kevin Bacon

is the center of the universe and all stretches out from that. (Laughs)

So one thing that I am getting from my investigation of the literature

and my discussion with you is that many of the people we typically

associate with common factors have some connection to you. Like Jerome

Frank.

SR: Yes, I went to Harvard with him and had associations with him.

BD: Carl Rogers.

SR: I presented with Carl Rogers in 1940 and spoke to his group in

1945.

BD: Sol Garfield

SR: He was here at Washington University. He is Professor Emeritus

also.

BD: And you knew Paul Hoch as well.

SR: Yes, well actually those things, I mean people interacted but that

doesn’t mean that they read everything that I published.

 The Dodo Bird 27

BD: True. So the fact that there is a gap in referencing you is not

really a problem for you.

SR: No, because that is the way that it works. I don’t think that the

citation of my work is that important. A lot of the same influences

that influenced me influenced them, except, perhaps, that they didn’t

have the same interest in history and literature, which brought me to

many different places. That was different. But I don’t like to stress

that because I don’t know that it’s that important and these people

wound up publishing a lot more on the common factors topic than me. And

a lot of times, people read things and take things in and forget where

ideas come from. That’s okay, that’s natural.

BD: Okay, but historically it’s important because it seems that after a

lull in discussion about common factors, a whole new generation of

common factors theorists started writing, and saying many things that

you said.

SR: I see. That was true even more so about my first paper, the 1933

paper. That paper was published in The Psychological Review, and

delineated the influences between the experimenter and the

experimentee. I pointed out the biases of the experimental relationship

which were later explored and developed by Orne and Rosenthal regarding

demand characteristics and experimental bias. Yes, those were

discovered separately by Rosenthal, Orne, and by other people, and they

didn’t cite my paper either.

BD: Okay.

SR: But Rosenthal was very aware of that and called me up about two

years ago on the phone. He said that he was just going to give a speech

to accept an award from the Society of Experimental Social Psychology.

He said that he wanted me to know that at the beginning of the speech

 The Dodo Bird 28

he was going to give me credit, that I should really be getting the

award.

BD: Well he could send you the award. (Both laugh).

SR: Well like I said, it has never really been that important to me,

never has been. Because I had been interested in something else by that

time. By the time someone was not referencing me, I was on to the next

thing. This isn’t about citations to me.

BD: That’s very interesting, you’re interested in something else, so

the fact that it’s not cited is not a problem for you. Actually, the

way it seemed to work out is that later theorists referenced those who

had been impacted by your work, missing the connection with your ideas.

It’s fascinating that you wrote two papers in the 30’s that were very

influential, but initially unrecognized, and then people take the ball

and run with it, get credit, and then the field finally starts

recognizing you.

SR: Well often people read something that interests them and then they

forget the source. That’s natural, that’s the way things go. And then

sometimes people don’t cite what came before because it lessens their

own contribution.

BD: They think it does.

SR: To me that’s not true. It’s important to some people to shine. What

is that ’15 minutes of fame,’ Who said that, Warhol? That’s the sort of

thing that many people are just dying to have.

BD: Yes, that’s true.

SR: Actually, the way the universe evolves and so on, in the end, what

is it about? What will it matter anyway, who said what and when, when I

am dead and buried? Ashes to ashes and dust to dust. My passion lies in

my current work. The joy is in the moment of discovery and so on-

that’s it. It’s like falling in love, it doesn’t last for twenty years,
 The Dodo Bird 29

or maybe it does. But it goes through an evolution. And maybe,

somewhere down the line, someone will pick up on it—if they reference

me fine, if not, that is the way it goes. I doubt if I’ll notice when

it is all said and done. And so on.

A Personal Note

It was a crisp, gorgeous autumn day in St. Louis. The leaves were

just starting to turn. The city was all a flutter because the Cardinals

were hosting the Mets in the National League Championship Series. The

beauty of day, the majesty of the mature trees just tinged with color,

and the background of playoff excitement forecast an enjoyable

adventure, perhaps even one that could approach my anticipations. It

was not only a delightful experience that I will always cherish, but it

also far exceeded all my expectations. I was impressed by Dr.

Rosenzweig in so many ways and at so many levels that I am still

sorting it all out.

Roediger (2000), perhaps best summarized Rosenzweig’s career:

He was friends with B.F. Skinner and he corresponded with Freud.

He helped usher in experimental studies of psychoanalytic

concepts, discussed implicit common factors in all therapies, and

his influence still resonates in theoretical and applied areas,

as well as in the careers of countless distinguished researchers.

When you talk about Saul Rosenzweig, you’re talking about the

history of psychology (p. 1).

Indeed, talking to him was like reading a novel about the history

of psychology; the textured and personal stories he told breathed life

into long forgotten names in long forgotten textbooks. Discussing his

contributions, traveling to lunch in his beloved Buick Skylark, meeting

his charming wife, Louise, and hearing about his current projects all

weave together in a way that was both educational and inspirational.

 The Dodo Bird 30

Dr. Rosenzweig not only taught me about the history of common factors,

he also taught me about scholarship, the ownership of ideas, and life.

His refreshing attitude toward his work and his lack of

resentment toward others achieving far more credit for similar ideas

was astounding. It stimulated a re-evaluation of my own reactions to

whether or not my colleagues and I are referenced, and an enhanced

appreciation of the privileges inherent to the intellectual pursuit of

ideas and their sharing with others. Saul Rosenzweig demonstrated the

joy of that privilege in his descriptions of the Rosenzweig Jubilee

held in his honor at Washington University. Many whose lives and work

had been touched by Dr. Rosenzweig came together to chronicle his

contributions and express their gratitude. I was taken by his pleasure

of that event—not in the credit given for his significant contributions

to the many different fields he has impacted, but rather in his pride

in teaching and inspiring others with his ideas. His work, his life,

and his amazing vitality and productivity offer not only hope of a

positive aging process, but also a glimpse of the rewards of the

unselfish and humble pursuit of ideas.

 The Dodo Bird 31

References

Duncan, B.L. (this issue). The legacy of Saul Rosenzweig: The

profundity of the dodo bird. Journal of Psychotherapy Integration.

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Fielder, F. E. (1950). The concept of an ideal therapeutic

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Frank, J.D. (1961). Persuasion and healing. Baltimore: Johns

Hopkins University Press.

Frank, J.D. (1973). Persuasion and healing (2nd ed.) Baltimore:

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Frank, J. D. (1982). Psychotherapy in America today. In M. R.

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Frank, J.D., Frank, J.B. (1991). Persuasion and healing (3rd

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Garfield, S. L. (1957). Introductory clinical psychology. New

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 The Dodo Bird 32

Goldfried, M. R., & Newman, C. F. (1992). A history of

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 The Dodo Bird 33

Rosenzweig, S. (1937). Schools of psychology: A complementary

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Shapiro A. K., & Morris, L. A. (1978). Placebo effects in medical

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 The Dodo Bird 34

Strupp, H. H., & Hadley, S. W. (1979). Specific vs non-specific

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 The Dodo Bird 35

Appendix

About Saul Rosenzweig

Saul Rosenzweig, born in Boston in 1907, received from Harvard

University in 1929 the B.A. degree, summa cum laude, in philosophy; in

1930, the M.A., and in 1932, the Ph.D. in clinical psychology. At the

newly established Harvard Psychological Clinic he worked as Research

Associate from 1929-1934. There, using laboratory methods, he

investigated the clinically derived concepts of psychoanalysis, e.g.,

repression. His first publication appeared in 1933 under the title “The

Experimental Situation as a Psychological Problem.” It anticipated the

flurry of research in the 1950’s on “experimenter bias” and related

problems in experimental social psychology.

In 1934, Rosenzweig joined the staff of the Research Service of

the Worcester State Hospital, Worcester, Massachusetts, where, until

1943, he participated in a multidisciplinary investigation of

schizophrenia, sponsored by the Rockefeller Foundation. He conducted

psychotherapy with schizophrenic patients and, in that context

developed concepts geared to the diverse problems and levels of

behavior. It was here that Rosenzwieg wrote his classic paper on common

factors and participated on the prophetic panel of Goodwin Watson with

Carl Rogers.

From 1938-1943, Rosenzweig was Affiliate Professor of Psychology

at Clark University in Worcester. During this period he developed the

Rosenzweig Picture-Frustration Study, based on a theory of aggression

in relation to frustration. This psychological instrument is now used

worldwide. The book, Aggressive Behavior and the Rosenzweig Picture-

Frustration Study appeared in 1978.

From 1943-1949, Rosenzweig was Chief Psychologist at the Western

State Psychiatric Institute, Pittsburgh, and Lecturer at the University

 The Dodo Bird 36

of Pittsburgh. Psychodiagnosis: An Introduction to Tests in the

Clinical Practice of Psychodynamics was published in 1949.

Since 1949, Rosenzweig has been professor in the Departments of

Psychology and Psychiatry at Washington University, St. Louis. In 1975

he was appointed Professor Emeritus. Significant events of this period

are: appointment to the Study Panel of the History of the Life

Sciences, National Institute of Health; establishment of the

International Society for Research on Aggression, of which Rosenzweig

was the founder and first president; the publication of the much cited

response to Hans Eysenck’s controversial paper; establishment of the

Foundation for Idiodynamics and the Creative Process in 1972, of which

he is the Managing Director.

In 1950 Rosenzweig introduced the approach of “Idiodynamics,”

which focuses on the dynamics of the life history by studying the

blending of the biogenic and cultural milieus in the matrix of the

idioverse (the individual world of events), with stress on the creative

process. In 1986, Rosenzweig published “Freud and Experimental

Psychology: the Emergence of Idiodynamics,” and in 1987, “Sally

Beauchamp’s Career: A Psychoarchaelogical Key to Morton Prince’s

Classic Case of Multiple Personality.” By idiodynamic methods, the

real-life identity of this patient was discovered and the etiology and

development of her mental disorder demonstrated. Rosenzweig is the

author of 200 other scientific, historical, and biographical articles,

including Freud, Jung, and Hall the Kingmaker, a New York Times

acclaimed book. This book applies the methods of idiodynamics to the

interactions of Freud, Jung, Hall, and James in connection with the

psychoanalytic expedition to America in 1909.

 The Dodo Bird 37

Running Head: THE LEGACY OF SAUL ROSENZWEIG

Duncan, B. (2002). The legacy of Saul Rosenzweig: The profundity of

the dodo bird. Journal of Psychotherapy Integration, 12, 32-57.

The Legacy of Saul Rosenzweig:

The Profundity of the Dodo Bird

Barry L. Duncan

Institute for the Study of Therapeutic Change

The author is indebted to Scott Miller, Jacqueline Sparks, and Mark

Hubble for our many collaborations, the results of which are

intertwined throughout this article. The author also thanks Jacqueline

Sparks for invaluable comments on this paper and Roberto Quiroz for

library assistance.
 The Dodo Bird 38

Abstract

This article provides commentary on Saul Rosenzweig’s classic 1936

paper, “Some Implicit Common Factors in Diverse Forms of

Psychotherapy,” with particular emphasis on his clever and prophetic

invocation of the dodo bird verdict from Alice In Wonderland. The

impact of this seminal contribution is discussed via a comparison of

Rosenzweig’s original common factors proposal with modern formulations

of common factors. The paradox inherent to the tenacious veracity of

the dodo bird verdict and the pursuit of empirically validated

treatments is explored. In the spirit of Rosenzweig’s legacy and the

wisdom of the dodo, this article suggests that psychotherapy abandon

the empirically bankrupt pursuit of prescriptive interventions for

specific disorders based in a medical model of psychopathology.

Instead, a call is made for a systematic application of the common

factors based in a relational model of client competence.

 The Dodo Bird 39

The Legacy of Saul Rosenzweig:

The Profundity of the Dodo Bird

The great tragedy of Science--the slaying of a beautiful hypothesis by

an ugly fact.

Thomas Henry Huxley, (1825-1895)

Although long enamored of common factors and their practical

application to psychotherapy practice and integration (Duncan & Miller,

2000a; Duncan & Moynihan, 1994; Duncan, Hubble, & Miller, 1997; Duncan,

Solovey, & Rusk, 1992; Hubble, Duncan, & Miller, 1999a; Miller, Duncan,

& Hubble, 1997), I only recently read Saul Rosenzweig’s classic 1936

paper, “Some Implicit Common Factors in Diverse Methods of

Psychotherapy.” Heretofore, I appreciated the article for its

historical significance as the first known articulation of common

factors in psychotherapy, which I had gleaned through other’s reference

and interpretation (e.g., Goldfried & Newman, 1992; Luborsky, 1995;

Weinberger, 1995). When the contribution to this volume motivated a

long overdue first-hand look, I was more than surprised to find the

dodo bird verdict from Alice in Wonderland used as an epigraph to begin

Rosenzweig’s paper (see his explanation for that choice in Duncan, this

issue).

Recall that in Alice in Wonderland (1865/1962), Lewis Carroll

tells the story of a race that was run to help the animals dry off

after they were soaked by Alice’s tears. The animals ran off helter

skelter in different directions, and the race was soon stopped. The

dodo bird was asked, “Who has won?” And he finally exclaimed the now

famous verdict, “Everybody has won, and all must have prizes.” The dodo

bird’s pronouncement has become not only a metaphor for the state of

psychotherapy outcome research, but also a symbol of a raging

controversy regarding the privileging of specific approaches for

 The Dodo Bird 40

specific disorders based upon demonstrated efficacy in randomized

clinical trials (e.g., Chambless & Hollon, 1998; Garfield, 1996;

Goldfried & Wolfe, 1998; Hubble, Duncan, & Miller, 1999b; Shapiro,

1996)—the so called empirically validated treatments.

Curiously few discussions of Rosenzweig’s article refer to his

creative application of Carroll’s famous race. The often perfunctory

accounts of Rosenzweig’s paper have perhaps missed its most profound

element: the clever invocation of the verdict to describe the

equivalence of effectiveness among psychotherapies. Many have

attributed the colorful and illustrative application of the dodo bird’s

judgement to Frank’s (1973) Persuasion and Healing. Perhaps most,

though, have credited Luborsky, Singer, and Luborsky (1975) for its use

in their groundbreaking summation of comparative studies of

psychotherapy.

Although Luborsky et al. cite Rosenzweig’s original application

in the second line of their own classic piece, most (with notable

exceptions, e.g., Weinberger, 1993) are either unaware of, or have

overlooked or forgotten that credit. Taking nothing away from Luborksy

et al., their invocation of the verdict was a perfect satiric fit

because of the horse race mentality of comparative studies, the

scattered directions that various approaches uncritically traveled, and

the resultant findings of no differences.

It was not until I read Rosenzweig’s article that I could grasp

its amazing clairvoyance—Luborsky et al. (1975) empirically confirmed

Rosenzweig’s crystal ball assessment of psychotherapy some forty years

earlier. He not only predicted nearly 65 years of data, Rosenzweig, in

1936, presented the classic argument, still used today, for a common

factors perspective—namely, because all approaches appear equal in

effectiveness, there must be pantheoretical factors in operation that

 The Dodo Bird 41

overshadow any perceived or presumed differences among approaches. In

short, he discussed the factors common to therapy as an explanation for

the observed comparable outcomes of varied approaches. His paper

represents far more than an historical footnote in the evolution of a

common factors perspective and deserves far more than an obligatory

tip-of-the-cap reference, of which, my colleagues and I are equally

guilty.

This article provides commentary on Rosenzweig’s prophetic paper

and its impact on contemporary psychotherapy. To accomplish this task,

Rosenzweig’s seminal contribution is compared with modern formulations

of common factors. The paradox inherent to the dodo bird verdict and

the pursuit of empirically validated treatments is explored. Finally,

in the spirit of Rosenzweig’s legacy and the wisdom of the dodo, this

article suggests that psychotherapy abandon the empirically bankrupt

pursuit of prescriptive interventions for specific disorders based in a

medical model of psychopathology. Instead, a call is made for a

systematic application of the common factors based in a relational

model of client competence.

Bonfire of the Vanities

Beware lest you lose the substance by grasping at the shadow.

Aesop (620-560 B.C.)

With Freud, psychotherapy was born. Yet, before he barely left a

mark on the professional landscape, his former disciples broke ranks,

proclaimed their theoretical differences, and promoted their own

versions of mental life and therapy. Since those days, the divisions

have multiplied. New schools of therapy now arrive with the regularity

of the Book-of-the-Month Club’s main selection (Hubble et al., 1999a).

Dating from the 1960's, the number of psychotherapy approaches

has grown approximately 600% (Miller et al., 1997). Although the actual
 The Dodo Bird 42

figures vary among observers, it is estimated that we now have more

than 200 therapy models and 400 techniques (Bergin & Garfield, 1994).

Veteran common factors theorist and researcher Sol Garfield said, “I am

inclined to predict that sometime in the next century there will be one

form of psychotherapy for every adult in the Western World!” (1987, p.

98). Most claim to be the corrective for all that came before,

professing to have the inside line on human motivation, the true causes

of psychological dysfunction, and the best remedies.

Once therapists broke the early taboo against observing and

researching therapy, they turned to proving empirically that their

therapies were the best. A generation of investigators ushered in the

age of comparative clinical trials. Winners and losers were to be had.

As Bergin and Lambert (1978) described this time, “Presumably, the one

shown to be most effective will prove that position to be correct and

will serve as a demonstration that the ‘losers’ should be persuaded to

give up their views” (p. 162). Thus, behavior, psychoanalytic, client-

centered or humanistic, rational-emotive, cognitive, time-limited,

time-unlimited, and other therapies were pitted against each other in a

great battle of the brands.

Nonetheless, all this sound and fury produced an unexpected

bonfire of the vanities (Hubble et al., 1999a). Put another way,

reiterating Huxley’s epigraph introducing this article, science slew a

beautiful hypothesis with an ugly fact. As Rosenzweig spelled out more

than 65 years ago, the underlying premise of the comparative studies,

that one (or more) therapies would prove superior to others, received

virtually no support (Bergin & Lambert, 1978; Sloane, Staples, Cristol,

Yorkston, & Whipple, 1975). Besides the occasional significant finding

for a particular therapy, the critical mass of data revealed no

differences in effectiveness between the various treatments for

 The Dodo Bird 43

psychological distress. Luborsky et al. (1975) re-invoked the dodo bird

to describe the findings of their review of comparative studies. Now,

more than twenty-five years later and many attempts to dismiss or

overturn it (see below), the dodo bird verdict still stands. Therapy

works, but our understanding of what works in therapy is unlikely to be

found in the insular explanations and a posteriori reasoning adopted by

the different theoretical orientations.

Common Factors: 1980 and Beyond

There is no new thing under the sun.

Bible, Ecclesiastes 1:9

Weinberger (1995) observes that after 1980, an outpouring of

writing began to appear on the common factors. Grencavage and Norcross

(1990) collected articles addressing common factors and note that a

positive relationship exists between year of publication and the number

of common factors proposals offered. Perhaps in response to the

comparative studies and reviews of the 70’s and 80’s (e.g., Luborsky et

al., 1975; Smith, Glass, & Miller, 1980; Shapiro & Shapiro, 1982;

Stiles, Shapiro, & Elliot, 1986)) reflecting the equivalence of

outcome, the 80’s gave rise to more prominence to common factors ideas,

particularly in the eclecticism/integration movement. Many noteworthy

common factors proposals have appeared (e.g., Arkowitz, 1992; Garfield,

1982; Goldfried, 1982; Miller et al., 1997; Patterson, 1989;

Weinberger, 1993).

Perhaps the most significant modern contribution to a common

factors perspective was made by Michael Lambert. After an extensive

review and analyses of decades of outcome research, Lambert (1992)

identified four therapeutic factors (extratherapeutic, common factors,

expectancy or placebo, and techniques) as the principal elements

accounting for improvement in psychotherapy. Inspired by Lambert’s

 The Dodo Bird 44

proposal, Miller et al. (1997) expanded the use of the term “common

factors” from its traditional meaning of nonspecific or relational

factors, to include four specific factors: client, relationship,

placebo, and technique. Interestingly, this interpretation of “common

factors” represents a return to Rosenzweig’s original formulation.

Based on this broader conceptual map of the common factors, Hubble et

al. 1999a assembled leading outcome researchers to review four decades

of investigation and reveal its implications for practice. The results

favored an increased emphasis on the client’s contribution to positive

outcome and provided a more specific delineation of clinical guidelines

(Duncan & Miller, 2000a; Hubble et al., 1999ab). The following is a

snapshot of the findings compared with Rosenzweig’s 1936 formulations.

Client Factors: The Heroic Client

Until lions have their historians, tales of hunting will always glorify

the hunter.

African Proverb

Clients have long been portrayed as the "unactualized," message

bearers of family dysfunction, manufacturers of resistance, and in most

therapeutic traditions, targets for the presumably all-important

technical intervention. Rarely is the client cast in the role of the

chief agent of change or even mentioned in advertisements announcing

the newest line of fashions in the therapy boutique of techniques

(Duncan & Miller, 2000a). Tallman and Bohart’s (1999) review of the

research makes clear, however, that the client is actually the single,

most potent contributor to outcome in psychotherapy--the resources

clients bring into the therapy room and what influences their lives

outside it (Miller et al., 1997). These factors might include

persistence, openness, faith, optimism, a supportive grandmother, or

membership in a religious community: all factors operative in a

 The Dodo Bird 45

client’s life before he or she enters therapy. They also include

serendipitous interactions between such inner strengths and

happenstance, such as a new job or a crisis successfully negotiated.

Assay and Lambert (1999) ascribe 40 percent of improvement during

psychotherapy to client factors. This hefty percentage represents a

departure from convention, considering that, as Tallman and Bohart

(1999) indicate, that most of what is written about therapy celebrates

the contribution of the therapist, therapist’s model, or technique.

Revisiting the dodo bird verdict, Bohart (2000) decries the field’s

persistent attempts to refute it and takes the common factors

interpretation of the verdict one step further. He asserts that

therapies work equally well because they share one very important, but

classically ignored ingredient—the client and his or her own

regenerative powers. The dodo bird verdict rings true, Bohart suggests,

because the client's abilities to change transcend any differences

among models.

If this is so, reason Tallman and Bohart (1999), then other

examples of the equivalence of outcome should occur. And they do. The

dodo bird verdict prevails not only across different approaches to

therapy, but also between professionals and paraprofessionals (Strupp &

Hadley, 1979), experienced and inexperienced therapists (Christensen &

Jacobson, 1994), psychotherapy and self-help (Arkowitz, 1997), and

self-help approaches (Gould & Clum, 1993).

If what was provided in therapy was the real deal, then

widespread uniform results would not be the norm. The data point to the

inevitable conclusion that the engine of change is the client (Tallman

& Bohart, 1999). Tallman and Bohart’s review strongly suggests that the

field reconsider its infatuation with model and technique and invest

more wisely in researching ways to employ the client in the process of

 The Dodo Bird 46

change. Bergin and Garfield (1994) note: “As therapists have depended

more upon the client's resources, more change seems to occur” (pp. 825-

826).

Rosenzweig (1936) spoke to the natural sagacity of the client to

take what therapy offers and make the best of it. First, he argued that

therapist formulations of the problem need only have enough relevance

to impress the client to begin the work of rehabilitation; therapy

serves to get the process of change started and need not be totally

“adequate”. Once started, Rosenzweig suggested that change ripples

through the “whole” of the individual’s personality. Because of the

interdependent organization of personality, explanations of various

theoretical origins may be effective because change in one area effects

the person’s life in total. Rosenzweig’s comments reflect a basic

belief in the client’s capacity for change and the enlistment of the

client in the change endeavor. In the era of Rosenzweig’s common

factors article, there seemed to be more respect for the potentialities

of clients as well as a stated appreciation of the uniqueness of the

individual (Duncan, this issue; Watson, 1940).

It is unfortunate that this perspective seems to have been

replaced by a psychopathological view of clients. Although some may

take offense by this characterization, psychotherapy has largely

evolved a perspective of clients as either “pathological monsters” or

“dimwitted plodders” (Duncan & Miller, 2000b). Of course, no

psychotherapist would say that he or she views clients as monsters or

plodders. They would deny characterizing clients as pathological

monsters while simultaneously diagnosing them with equally devastating

labels reflecting equally non-complimentary descriptions. They would

bristle at any assessment of their clients as dimwitted plodders while

concurrently prescribing empirically validated treatments, relegating

 The Dodo Bird 47

the client to a disembodied illness to be intervened upon, instead of

contributing, resourceful partner with whom to discuss options. One

only has to examine the texts of therapist talk, the countless number

of therapist’s tales of conquest over client psychopathology, to

discover the cult of client incompetence so pervasive in our field. The

hyperbolic depiction of clients as monsters or plodders opens up the

hidden assumptions of psychotherapy--the heroic therapist riding a

white stallion of expert knowledge brandishing a sword of validated

treatments rescuing the poor dysfunctional patient plagued by the

dragon of mental illness--to examination.

Clients are the main characters, the heroes and heroines of

therapeutic stage and are the most potent contributor to

psychotherapeutic change (Bohart & Tallman, 1999; Duncan & Miller,

2000a). This common factor suggests that therapists eschew the five D’s

of client desecration (diagnosis, deficits, disorders, diseases, and

dysfunction), and instead find ways to enlist the client in service of

client goals. Whatever path the psychotherapist takes, it is important

to remember that the purpose is to identify not what clients need, but

what they already have that can be put to use in reaching their goals

(see Hubble et al., 1999a for practical clinical suggestions for

enrolling client factors).

Relationship Factors: On the Shoulders of Carl Rogers

Some patients, though conscious that their condition is perilous,

recover their health simply through their contentment with the goodness

of the physician.

--Hippocrates

The next class of factors accounts for 30% of successful outcome

variance (Assay & Lambert, 1999) and represents a wide range of

relationship-mediated variables found among therapies no matter the

 The Dodo Bird 48

therapist’s theoretical persuasion. Therapist-provided variables,

especially the core conditions popularized by Carl Rogers (1957), have

not only been empirically supported, but are also remarkably consistent

in client reports of successful therapy (Lambert, 1992). Bachelor and

Horvath (1999) convincingly argue that next to what the client brings

to therapy, the therapeutic relationship is responsible for most of the

gains resulting from therapy.

Rosenzweig (1936) comments on the power of therapist provided

variables:

. ...the personality of the therapist would be sufficient in

itself, apart everything else, to account for the cure of many a

patient by a sort of catalytic effect. Since no one method of

therapy has a monopoly on all the good therapists, another

potentially common factor is available to help account for the

equal success of avowedly different methods (p. 413).

Further, client perceptions of the relationship are the most

consistent predictor of improvement (Gurman, 1977). For example, Blatt,

Zuroff, Quinlan, and Pilkonis (1996) analyzed client perceptions of the

relationship in the Treatment of Depression Collaborative Research

Project (TDCRP). Like many other studies, improvement was minimally

related to the type of treatment received (even drug treatment), but

substantially determined by the client-rated quality of the

relationship. Its significance transcends our cherished theoretical

schools, our favorite techniques, our most worshipped gurus, and even

the privilege attributed to medication.

Researchers have expanded the relationship beyond the therapist

provided variables to the broader concept of the “alliance.” The

alliance speaks to both therapist and client contributions, and

emphasizes the partnership between the client and therapist to achieve

 The Dodo Bird 49

the client’s goals (Bordin, 1979). Research on the power of the

alliance reflects over 1,000 findings (Orlinsky, Grawe, & Park, 1994)

and is particularly noteworthy when taken from the client’s

perspective. For example, Krupnick et al. (1996) analyzed data from the

TDCRP and found that the alliance was most predictive of success for

all conditions. In another large study of diverse therapies for

alcoholism, the alliance was also significantly predictive of success

(Connors, DiClemente, Carroll, Longabaugh, & Donovan, 1997). Moreover,

the data suggest that the alliance quality itself is an active factor

(Gaston, Marmar, Thompson, & Gallagher, 1991). Thus, the relationship

produces change and is not only a reflection of beneficial results

(Lambert & Bergin, 1994).

This unequivocal link between the client’s rating of the alliance

and successful outcome makes a strong case for a different emphasis in

psychotherapy--on tailoring therapy to the client’s perceptions of a

positive alliance. To do this on day-to-day basis requires avid

attention to the client’s goals, and careful monitoring of the client’s

reaction to comments, explanations, interpretations, questions, and

suggestions. It also demands a higher measure of flexibility on the

part of the therapist and a willingness to change one’s relational

stance to fit with the client’s perceptions of what is most helpful

(Norcross & Beutler, 1997). Offering a primitive version of Norcross

and Beutler’s notion of relationships of choice, Rosenzweig (1936)

discusses the importance of finding the best match between the client

and psychotherapist’s personality.

Some clients, for instance, will prefer a formal or professional

manner over a casual or warmer one. Others might prefer more self-

disclosure from their therapist, greater directiveness, a focus on

their symptoms or a focus on the possible meanings beneath them, a

 The Dodo Bird 50

faster or perhaps, a more laid back pace for therapeutic work (Bachelor

& Horvath, 1999). Clearly, the one-approach fits all is a strategy

guarantied to undermine alliance formation (see Hubble et al., 1999 for

practical clinical suggestions for enhancing relationship factors).

Placebo, Hope, and Expectancy: Remoralization is the Key

One should treat as many patients as possible with a new drug while it

still has the power to heal.

--Sir William Osler (1849-1919)

Following client and relationship factors, comes placebo, hope,

and expectancy. Assay and Lambert (1999) put its contribution to

psychotherapy outcome at 15%. In part, this class of therapeutic

factors refers to the portion of improvement deriving from client’s

knowledge of being treated and assessment of the credibility of the

therapy’s rationale and related techniques. Expectancy parallels

Frank’s idea that in successful therapies both client and therapist

believe in the restorative power of the treatment’s procedures or

rituals. These curative effects, therefore, are not thought to derive

specifically from a given treatment procedure; they come from the

positive and hopeful expectations that accompany the use and

implementation of the method. Frank’s (1973) classic discussion of

remoralization as the final common pathway of all therapeutic

intervention speaks to the power of hope to counter the most

demoralized client.

Rosenzweig speaks to the power of expectation invoked by the

therapist’s belief in the method when he says, “The very one-sidedness

of an ardently espoused therapeutic doctrine might on these grounds

have a favorable effect” (p. 413-414). In his 1940 panel presentation

(Watson, 1940), Rosenzweig discussed faith and confidence of the client

 The Dodo Bird 51

as part and parcel to the success of the therapist’s suggestions, and a

factor common to all therapies.

Rituals are a shared characteristic of healing procedures in most

cultures and date back to the earliest origins of human society (Frank

& Frank, 1991). Their use inspires hope and a positive expectation for

change by conveying that the user--shaman, astrologer, or

psychotherapist--possesses a special set of skills for healing. That

the procedures are not in and of themselves the causal agents of change

matters little (Kottler, 1991). What does matter is that the

participants have a structured, concrete method for mobilizing the

placebo factors. From this perspective, any technique from any model

may be viewed as a healing ritual, rich in the possibility that hope

and expectancy can inspire (see Hubble et al., 1999a for practical

clinical suggestions for enhancing expectancy factors).

Model/Technique Factors

Do not become the slave of your model.

--Vincent van Gogh (1853-1890)

Models and techniques are the last of the four factors. Like

expectancy, Assay & Lambert (1999) suggests that they account for 15%

of improvement in therapy. In a narrow sense, model/technique factors

may be regarded as beliefs and procedures unique to specific

treatments. The miracle question in solution-focused therapy, the use

of thought restructuring in cognitive-behavioral therapy, hypnosis,

systematic desensitization, biofeedback, transference interpretations,

and the respective theoretical premises attending these practices are

exemplary.

In concert with Frank and Rosenzweig, model/technique factors can

be interpreted more broadly as therapeutic or healing rituals. When

viewed as a healing ritual, even the latest therapies (e.g., EMDR)

 The Dodo Bird 52

offer nothing new. Healing rituals have been a part of psychotherapy

dating back to the modern origins of the field (Wolberg, 1977). Whether

instructing clients to lie on a couch, talk to an empty chair, or chart

negative self-talk, mental health professionals are engaging in healing

rituals. Because comparisons of therapy techniques have found little

differential efficacy, they may all be understood as healing rituals--

technically inert, but nonetheless powerful, organized methods for

enhancing the effects of placebo factors.

They include a rationale, offer a novel explanation for the

client’s difficulties, and establish strategies or procedures to follow

for resolving them. Depending on the clinician’s theoretical

orientation, different content is emphasized. Rosenzweig proposed that

whether the therapist talks in terms of psychoanalysis or Christian

Science is unimportant. Rather it is the formal consistency with which

the doctrine employed is adhered to, thereby offering a systematic

basis for change and an alternative formulation to the client.

In his conclusions, although making the point that common factors

are primary, Rosenzweig forecasts modern integrative efforts when he

suggests that therapists have a repertoire of methods to draw upon to

adapt to the individual case (technical eclecticism, e.g., Lazarus,

1992). In his 1940 presentation, Rosenzweig again suggested that the

content of any alternative conceptualization was unimportant.

Remarkably, he noted the status of relativism in psychotherapy, and the

importance of “fitness” of special procedures to special clients--an

early version of matching characteristics (Beutler & Clarkin, 1990), or

what Duncan and Miller (2000b) call honoring the client’s theory or

change.

How exactly should models be viewed when so much outcome variance

is controlled by other factors--85% to be exact (40% client factors,

 The Dodo Bird 53

30% relationship factors, and 15% expectancy factors)? In addition to

the provision of novelty to clients, models and techniques provide

alternative ways of conceptualizing and conducting therapy for

therapists when progress is not forthcoming. With over 400 models and

techniques to choose from, there is little reason for continued

allegiance to a particular approach when it is not producing results.

No blame need be assigned; psychotherapists and clients can simply

change their minds, go back to the smorgasbord, so to speak, and make

another selection (Hubble et al., 1999).

The different schools of therapy, therefore, may be at their most

helpful when they provide psychotherapists with novel ways of looking

at old situations, when they empower therapists to change rather than

make up their minds about clients (Miller et al., 1997). Models that

better enlist the clients unique talents, help the therapist approach

the client’s goals differently, establish a better match with the

client’s own theory of change (Duncan & Miller, 2000b), or utilize

environmental supports are likely to prove the most beneficial in

resolving a treatment impasse.

It is helpful to stand back from the squabbles over whose is

best, and consider what it means to regard models and techniques as

part of the pantheoretical factors shared by all effective therapies.

When viewed from this vantage point, models and technique no longer

reflect a particular theoretical doctrine or school. Instead, as Simon

(1996) has suggested, they become "a practice which teaches the

therapist, through naming, enactment, and talking to colleagues, the

attitudes and values from which [therapeutic] work is generated” (p.

53).

Therefore, models and techniques help provide therapists with

replicable and structured ways for developing/practicing the values,

 The Dodo Bird 54

attitudes, and behaviors consistent with the core ingredients of

effective therapy. This nontraditional role for models/techniques

suggests that their principal contribution to therapy comes about by

enhancing the potency of the other common factors--client,

relationship, and placebo (see Hubble et al., 1999b for a discussion of

developing techniques from a common factors perspective that honor the

client’s theory of change).

The Dodo Bird Verdict Persists

If a man will kick a fact out the window, when he comes back he finds

it again in the chimney corner.

--Ralph Waldo Emerson (1842)

Luborsky et al.’s (1975) analyses of comparative studies still

rings true. Later sophisticated comparative clinical trials and

comprehensive reviews have drawn similar conclusions (e.g., Elkin et

al., 1989; Lambert & Bergin, 1994). The Consumer Reports survey, too,

offered no evidence for differential effectiveness of therapies for any

disorder (Seligman, 1995). Moreover, the most recent meta-analyses, an

impressive investigation designed specifically to test the dodo

verdict, once again, has reconfirmed the bird’s wise judgement

(Wampold, Mondin, Moody, Stich, Benson, & Ahn, 1997). Finally, a real

world study conducted by managed care giant Human Affairs International

of over 2000 psychotherapists revealed no differences in outcome among

various approaches, including medication (Brown, Dreis, & Nace, 1999).

The miniscule numbers of studies that have demonstrated superiority of

one model over another are no more than would be expected by chance

(Wampold, 1997).

So, despite the fortunes spent on weekend workshops selling the

latest fashion, the competition among the more than 250 therapeutic

schools, to expand on Frank’s classic analogy, amounts to little more

 The Dodo Bird 55

than the competition among aspirin, Advil, and Tylenol. All of them

relieve pain and work better than no treatment at all. None stands head

and shoulders above the rest. Why is the dodo bird’s wisdom ignored?

Bohart (2000) asserts:

There is so much data for this conclusion that if it were not so

threatening to special theories it would long ago have been

accepted as one of psychology’s major findings. Then it would

have been built upon and explored instead of continually being

debated. The data call for a change in how we view therapy, but

the field continues to stick to the old technique-focused

paradigm. (p. 129).

There are two other reasons why the field is model maniacal. The

quest for the Holy Grail presses onward because of the desire to find

some definitive answer about ameliorating human suffering—keeping

psychotherapists dangerously enamored of flashy techniques and the

promise of miracle cures. Exploiting such strivings as well as fears of

managed care, workshop brochures and book announcements regularly

bombard clinicians with what’s new and different.

Unfortunately, finding THE cure always seems just out of reach.

Therapists learn finger tapping, finger waving, miracle questions, and

other highly publicized methods of treatment. Self proclaimed experts

present mysterious scans of brains showing incontrovertible truth that

“mental illness” exists and medical science is on the verge of

conquering it. But when reality sits in, therapists know that they can

never produce the epic transformations witnessed on videos or reported

in edited transcripts. Psychotherapists painfully recognize that

colorized brain images won’t help when they are alone in their offices

facing the pain of people in dire circumstances. Amid explanations and

remedies aplenty, beleaguered and growing in cynicism, therapists

 The Dodo Bird 56

courageously continue the search for designer explanations and brand

name miracles—distracted and disconnected from the power for change

that resides in their clients and the quality of partnership that can

be achieved.

The other reason that the dodo bird verdict is ignored is that

clinicians are indoctrinated to privilege model and technique by

graduate programs, professional organizations, and managed care

companies. Political and economic factors loom large. Along with the

explosion of treatment methods, there has been an unprecedented

expansion in the number of mental health practitioners. With so many to

choose from, the inevitable competition for jobs, prestige, and

influence markedly spiraled.

Psychiatrists, arguably better positioned because of their

historical hegemony in health care, have prepared and distributed

practice guidelines targeting specific treatments (drugs) for specific

disorders. To ensure their continued viability in the market,

psychologists have rushed to offer magic bullets to counter

psychiatry’s magic pills, to establish empirically validated or

supported treatments (EVT). EVTs are promoted as the rallying point, a

“common cause” for a clinical profession fighting exclusion (Nathan,

1997, p. 10). The now famous (or infamous) task force of APA (Task

Force on Promotion and Dissemination of Psychological Procedures, 1995)

was given the job of cataloguing treatments of choice for specific

diagnoses. To make the EVT list, an approach need only demonstrate its

efficacy, or superiority over placebo, in two studies.

Empirically or Politically Validated Treatments?

Seek facts and classify them and you will be the workmen of science.

Conceive or accept theories and you will be their politicians.

Nicholas Maurice Arthus (1862-1945)

 The Dodo Bird 57

The good intentions of saving psychology’s market share

notwithstanding, declaring an approach to be an EVT and suggesting that

it should therefore be the prescribed treatment of choice is empirical

bankruptcy. After their extensive meta-analytic reconfirmation of the

dodo bird verdict, Wampold et al. (1997) conclude:

Unfortunately, the empirical validation strategy weakens support

for psychotherapy as a mental health treatment rather than

strengthens it. Why is it that researchers persist in attempts to

find treatment differences, when they know that these effects are

small in comparison to other effects…or treatment versus no

treatment comparisons…? (p. 211).

EVTs equate the client with the problem and describe the

treatment as if it is isolated from the most powerful factors that

contribute to change--the client’s resources, perceptions of the

alliance, and participation. The EVT position virtually ignores forty

years of outcome data about common factors and the veracity of the dodo

bird verdict. Model factors are pale in comparison to client and

relationship factors; efficacy over placebo is not differential

efficacy over other approaches. Shapiro (1996) suggests, “The Task

Force might build a better case for psychotherapy from common factors

research that by citing a rather short list of ‘validated’ methods’ (p.

257).

The EVT house of cards is built on the foundation of the medical

model: diagnosis plus prescriptive treatment equals symptom

amelioration (see Bohart, 2000). George Albee (1998), vociferous critic

of the medical model, suggested that psychology made a Faustian deal

with the medical model over fifty years ago when it uncritically

accepted the call to provide psychiatric services to returning

veterans. The medical model was perhaps permanently stamped, however,

 The Dodo Bird 58

at the famed Boulder conference in 1949, where psychology’s bible of

training was developed with an acceptance of medical language and the

concept of mental disease (Albee, 2000).

Later, with the passing of freedom of choice legislation

guaranteeing parity with psychiatrists, psychologists learned to treat

clients in private offices and collect from third-party payers

requiring only a psychiatric diagnosis for reimbursement. Soon

thereafter, the rising tide of the medical model of mental health

reached dangerous levels of influence. Drowning any possibilities for

other psychosocial systems of understanding human challenges, the

National Institute of Mental Health (NIMH), the leading source of

research funding for psychotherapy, decided to apply the same

methodology used in drug research to evaluate psychotherapy (Goldfried

& Wolfe, 1996)—the randomized clinical trial (RCT).

Commenting on the RCT, Goldfried and Wolfe (1996) state:

…psychotherapy outcome researchers may have overreacted and moved

the field in the wrong direction…it has become overly dependent on the

‘clinical trials’ method to determine how to best treat ‘disorders.’ In

addition to condoning the medicalization of psychotherapy,

psychotherapy researchers may unwittingly be playing into the hands of

third-party payers in placing unwarranted emphasis on the putative

fixed efficacy of specific interventions (p. 1007).

Adopting the RCT methodology for evaluating psychotherapy had

profound effects. It meant that a study must include manualized

therapies (to approximate drug protocols) and Diagnostic and

Statistical Manual (DSM) (American Psychiatric Association, 1994)

defined disorders to be eligible for a NIMH sponsored research grant

(Goldfried & Wolfe, 1998). The result: Funding for studies not related

to a specific disorders dropped nearly 200% from the late 1980's to

 The Dodo Bird 59

1990 (Wolfe, 1993). In addition to these limiting effects, force

fitting the RCT on psychotherapy research is empirical tyranny and

bereft of scientific reasoning.

The randomized clinical trial (RCT) compares the effects of a

drug (an active compound) to a placebo (a therapeutically inert or

inactive substance) for a specific illness. The basic assumption of the

RCT is that the active (unique) ingredients of different drugs (or

psychotherapies) will produce different effects with different

disorders. The field has already been there and done that--the dodo

bird verdict is a reality and the active ingredients model (or drug

metaphor, Stiles & Shapiro, 1989) borrowed from medicine doesn’t fit

(Wampold et al., 1997).

For example, most EVTs come from the cognitive-behavioral

therapy (CBT) schools (Chambless, 1996). Not only have the active

ingredients of CBT failed to be validated (Jacobson et al., 1996), but

also have been found to have a negative correlation to outcome when

emphasized (Castonguay, Goldfried, Wiser, Raul, & Hayes, 1996). The

ascendancy of CBT on the EVT list speaks more to its privilege of being

researched than to any privilege it has earned by being researched.

Despite the dodo bird verdict and the difficulty in validating specific

effects, the task force, not unlike the pigs in Orwell’s Animal Farm,

continues to assert that some therapies are more equal than others.

Guild and market pressures, not science, motivate this assertion.

Further, the RCT measures outcome by a symptomatic reduction of

DSM disorders. The RCT itself suffers from diagnostic disorder (Duncan

& Miller, 2000a). Characteristics are: a) notoriously poor reliability

(Carson, 1997; Kirk & Kutchins, 1992); b) poor validity—the DSM neither

selects the appropriate treatment (Garfield, 1986) nor predicts outcome

(Beutler & Clarkin, 1990; Brown et al., 1999); c) does not capture the
 The Dodo Bird 60

variety of reasons for which people seek therapy (e.g., relational

difficulties, unrealized potential, the struggles of everyday

existence, etc.); and d) does not describe the diversity of ways that

success is defined (e.g., satisfactory relationships, increased self

esteem, a plan for the future, etc.) (Beutler & Clarkin, 1990;

Goldfried & Wolfe, 1998).

Finally, the findings of RCT’s are profoundly limited because

they do not generalize to the way psychotherapy is conducted in the

real world. Efficacy in randomized clinical trials does not equate to

effectiveness in clinical settings; internal validity does not ensure

external validity (Goldfried & Wolfe, 1998). The RCT randomly assigns

members of a homogeneous group of clients--sorted by their diagnosis--

to manualized treatment conditions.

Doing therapy by a manual is like having sex by a manual. Perhaps

the desired outcome is achieved if instructions are technically

followed. But the nuances and creativity of an actual encounter flows

from the moment to moment interaction of the participants, not from

step a to step b. Experienced therapists know that psychotherapy

requires the unique tailoring of any approach to a particular client

and circumstance (Watson, 1940). Simply put, psychotherapists do not do

therapy by the book. When they do, it does not go very well (Castonquay

et al. 1996; Henry, Strupp, Butler, Schacht, & Binder, 1993).

The conclusion is inescapable. The RCT is inadequate for

empirically validating psychotherapy as practiced in the real world

(Seligman, 1995). Unlike the RCT, in actual clinical practice, manuals

are not used, therapies are not ever purely practiced, clients are not

randomly assigned to treatments, and clients rarely, if ever, enter

therapy for singular DSM defined disorders or experience success solely

as diagnostic symptom reduction.

 The Dodo Bird 61

The EVT position is not only selective science at its worst, it

is another brick in the wall of medical model privilege in

psychotherapy. The end result of our Faustian deal with the medical

model: Psychotherapy is now almost exclusively described, researched,

taught, and practiced in terms of pathology and prescriptive treatments

and is firmly entrenched in our professional associations, licensing

boards, and academic institutions. It is so taken for granted that it

is like the old story about a fish in water. You ask a fish, “How’s the

water?” and the fish replies, “What water?”

Concurrently, psychotherapists of all flavors find themselves at

their most undervalued point in history. The reality is, as former APA

president Nicholas Cummings predicted a decade and a half ago, non-

medical helping professionals have become, “poorly paid and little

respected employees of giant health care corporations” (1986, p. 426).

This is not a coincidence.

Many blame managed care. Managed care, however, is not the real

problem (Duncan & Miller, 2000a). They are merely bouncers who strong-

arm clinicians into using proper diagnoses and prescriptive treatments.

Managed care has only reified practices that before were merely

annoyances to endure for reimbursement. Though grotesque, managed care

is, like Frankenstein, a monster made by our complicity in our own

image—a misunderstood, but dangerous set of empirically dead standards

pieced together running amuck and terrorizing the locals.

For example, managed care increasingly dictates the approach

therapists must use with specific diagnoses to receive reimbursement.

One need only look in the mirror to see where managed care got the idea

that certain approaches are more effective than others, or that

specific intervention is causally related to psychotherapeutic change.

Further, diagnosis is perhaps the most significant covenant of our

 The Dodo Bird 62

Faustian deal, the mainstay of getting paid by insurance companies.

Curiously, psychotherapists have hated the DSM since its inception.

Surveys of therapists of all stripes well into the 80’s show that a

substantial majority had a basic contempt for it on ethical,

scientific, and practical levels (Kirk & Kutchins, 1992). Yet, despite

this traditional discomfort with diagnoses, there has been no charge

mounted to dethrone it as king of reimbursement.

The growing preference for medication among managed care

companies is another painful example. With a few recent exceptions, the

debate that once raged over the value of psychotropic drugs has all but

disappeared. Like Dr. Frankenstein, we have only ourselves to blame for

the damage inflicted by our creation. APA continues to press for

prescription privileges for psychologists, an endorsement of medication

to say the least. The APA Monitor not only regularly pummels the reader

with prescription privilege updates and photo ops for its politicians,

but also now includes drug company advertisements. What is ironic about

psychology’s “prescription envy” is the lack of scientific support of

drug efficacy, especially over psychotherapy (Duncan & Miller, 2000a;

Greenberg & Fisher, 1997; Greenberg, 1999; Kirsch & Sapirstein, 1998),

and the appalling problem of conflicts of interest with pharmaceutical

companies (Duncan, Miller, & Sparks, 2000). Like Frankenstein, the

frenzy to gain prescriptive authority is based more on folklore than

data, more on science fiction than science fact. What is particularly

ironic is that APA prides itself on its empirical heritage.

Managed care is not the problem. The medical model is not the

problem. Privileging the medical model over the data is the problem.

The medical model does not explain the process of change in

psychotherapy (client and alliance factors most important, not

treatment technique), select the appropriate treatment (the dodo bird

 The Dodo Bird 63

verdict), predict probable outcomes (diagnosis nor type of treatment

predict outcome, but client ratings of the alliance do), nor permit the

questions about psychotherapy that research could address (the RCT or

drug metaphor is inherently limiting).

Psychotherapy Future

Whoever acquires knowledge and does not practice it resembles him who

ploughs his land and leaves it unsown.

Sa’di Gulistan (1258)

In time, if current fashions continue, the continued diminution

of psychotherapy looks assured. Unless we come together, we may find

ourselves sharing the same status as the real dodo bird of Mauritius

and Reunion--extinct, or perhaps even worse, totally medicalized,

disconnected from any separate identity, absorbed by the conglomerate

of managed health care.

Charles Kiesler, noted psychologist and public policy analyst,

recently foretold the future of psychotherapy (2000). His clairvoyance,

in 1988, predicted many of the changes about to be ushered by the

managed health care revolution (Kiesler & Morton, 1988). Keisler has

once again gazed into his crystal ball and sees a more substantial set

of changes in the near future. Thus far in the managed care system,

mental health and substance abuse services have been separately

considered from general health care. Keisler predicts a sweeping change

in the future that “carves in” these services, following the pattern of

other specialty medical services once considered as “carve-outs.”

Advantages include increased cost effectiveness, increased efficiency,

an integrated database, and better tracking and coordination of care.

The implications: The patient of the future will encounter an

integrated system of mental and medical care, a partnership of

behavioral health providers, physicians, and nurses under one roof.

 The Dodo Bird 64

Patients will have one port of entry via the family physician and enjoy

one stop shopping for all their mental and medical health care needs.

Kiesler (2000) recommends that mental health professionals begin now to

prepare themselves by developing more protocols for specific disorders

and standards of care for those patients resistant to having their

problems identified as mental. The psychotherapist of the future will

be a specialist in treating specific disorders with highly standardized

psychotherapeutic interventions—empirically validated protocols for DSM

diagnoses.

Evidence of Keisler’s premonition already exists. In the May 2000

New England Journal of Medicine, an editorial advised physicians to

refer patients to therapists proficient at manualized cognitive

behavioral therapy for chronic depression. Unfortunately, physicians

have not been educated about the dodo bird verdict, nor do they

understand what the data say about how change occurs in psychotherapy.

Mental health treatment assimilated into the health care Borg

further aligns mental health with medicine, and psychotherapy finally

abandons what remnants remain of its humanistic, relational past. At

the heart of this new integrated system foretold by Keisler is an

abiding mistrust of client wisdom, client resources, and the right of

clients to be part of their own treatment and recovery.

Psychotherapists are not only relegated to the role of technicians of

protocoled treatments, but are also given the part of compliance cops--

responsible for those renegade patients who resist the “for their own

good” treatment (Duncan, in press).

Kiesler’s vision is the final act of the Faustian tragedy, our

deal with the medical model (Albee, 1998)—and the logical conclusion of

the EVT position. Psychotherapy is dispensed like a medication, an

intervention to order by a presiding physician at the first sign of

 The Dodo Bird 65

mental illness detected during a routine physical or perusal of an

integrated database (Big Brother) that reveals a relative’s mental

illness. It is the ironic climax of what Ogles, Anderson, and Lunnen,

(1999) call the great contradiction of modern psychotherapy: namely

that training and practice is geared toward specific treatments for

specific disorders despite the bulk of the data showing little real

difference among approaches.

Keisler’s premonition, like Scrooge’s visit from the Ghost of

Christmas Future in the Charles Dickens classic, can provide a much-

needed wake-up call for re-evaluation and action. Can we grant

ourselves a second chance and forestall this ghostly future?

Last Call For the Common Factors

To follow knowledge like a sinking star,

Beyond the upmost bound of human thought…

To strive, to seek, to find, and not to yield.

-- Lord Alfred Tennyson, Ulysses (1842)

Unless revolutionary new findings emerge, the knowledge of what

makes therapy effective is already in the hands of mental health

professionals. More than forty years of research already points the way

toward the defining role of common factors. A common factors vision of

therapy embraces change that is client directed not theory driven,

subscribes to a relational rather than medical model, and is committed

to successful outcome instead of competent (manualized) service

delivery (Duncan & Miller, 2000b).

A systematic application of the common factors starts with the

recasting of the drama of therapy and retiring the script that stars

the psychotherapist. Clients are the true heroes and heroines of the

therapeutic stage. Miscasting therapists as the stars has only served

to disconnect them from the local knowledge, strengths, and expertise

 The Dodo Bird 66

of their clients, factors that far outweigh any model or technique.

Applying this common factor, though, must go beyond the confines of

enlisting the client and his or her resources in the therapy room. It

must include entering full partnerships with clients at the multiple

levels at which decisions are made—partnerships to make psychotherapy

effective, accountable, and just (Duncan, in press; Duncan & Sparks, in

press).

A psychotherapy that sees clients as heroic gives voice to what

has always been present but never heard—not only in therapy itself, but

also in the very culture of psychotherapy. When cases are discussed

without clients’ voices, when supervision occurs from the supervisor’s

perspective, when the DSM is read without eye contact with the person

being described, the client is depersonalized—becomes a cardboard

cutout—and only suits the purposes of the therapist/supervisor/author.

With the addition of the client’s voice, the client emerges as a

thinking, deciding agent whose deliberations about his or her life and

the best course of action are reasonable and well executed, a part of a

never-ending story with many possible conclusions.

To fully operationalize this most potent common factor, the

client, therapists must not only enroll clients’ resources, invite

their perceptions, and enlist their participation, they must also ask

“Why?” of their colleagues and institutions--when diagnosis is

required, when prescriptive treatments are privileged, when clients are

portrayed as Godzillas or hapless bozos. Clients’ voices can be

included and valued in our supervision and case discussions, as well as

case records. Clients can attend staffings and case conferences, and

participate in behind the mirror brainstorming. Psychotherapists can

resist calling clients by case numbers, diagnoses, or pet case names.

Simply put, we can refuse to participate in professional jargon,

 The Dodo Bird 67

labeling, and preset treatment protocols that do not involve clients as

equal, indeed essential, and worthy members of the treatment team.

At the same time, psychotherapists can go out of their way to

support the client’s resistance to standard procedure—to struggle and

to devise plans of action that uniquely fit their preferences and

goals. If clients want to “drop out” of therapy, go to their local

religious advisor instead of a “mental health professional,” try a new

life plan that may not include medication or therapy, then this should

be trusted and encouraged. A trusting stance communicates to clients

our faith in them and their choices and may, perhaps be the biggest and

best “intervention” psychotherapists can make.

This may be risky. Not for reasons that risk management attorneys

preach, but because such a stance challenges the ways of being with

clients that builds in mistrust and therefore may promote

marginalization by peers for stepping outside the bounds of standard

practice. The belief in client capacity to conquer even extreme

personal circumstances must go deep. And the belief that clients want

better lives and have some general ideas about ways to get there must

transcend the inherent bias toward client incapacity, unwillingness,

and ignorance that a medical model therapy promotes. When

psychotherapists know the data that speak to client resourcefulness

(and look for and build on it in research and practice), then

psychotherapists can confidently refashion a medicalized identity--from

expert clinician to expert “clientician,” from a master of EVTs to a

master at forming partnerships that enroll clients strengths and

facilitate client goals (Duncan, in press; Duncan & Sparks, in press).

Such a partnership, based in a relational model of change

(Bohart, 2000; Duncan & Miller, 2000a), highlights what therapists do

best and incorporates how psychotherapists contribute most to the

 The Dodo Bird 68

change process. Aligning with the overwhelming data of the alliance, a

relational model sees change as emerging from an empowering,

collaborative interpersonal context. Psychotherapists must be skilled

at showcasing client talents, forming alliances with those that others

find difficult, and structuring therapy around client goals and

preferences. Further, therapists basing their work in a relational

model flexibly adapt any of a number of relational stances or

approaches to the values and beliefs of clients, matching their

expectations with relative ease and psychological comfort. Increased

choice for the client are at the heart of a relational model—including

an appreciation of the diminished choices that poverty, discrimination,

and exploitation bring as major sources of human dilemmas, and

consequently, of human distress.

Psychotherapists also have to make a living. Let’s face it:

Managed care rules and cost is king. How can psychotherapy use this

simple economic fact to advantage? How do we out-manage managed care?

It starts with the realization that current practices within managed

care are not working that well. The micro-management of mental health

services via treatment plans, periodic reviews, and the like amount to

an enormous waste of time and resources and disburse additional

sessions to cases that are not changing. Hardly cost effective.

Similarly counterproductive is the indiscriminate slashing of

provider pay—-up to 50% in some cases. This only encourages

psychotherapists to fly the coup at the first opportunity, which

requires managed care to continuously replenish their panels from an

endless supply of eager young therapists anxious to make it in practice

and willing to work for less and less. This revolving door bureaucratic

mess obviously has little regard to the actual quality or outcome of

services. It is, therefore, anything but cost effective.

 The Dodo Bird 69

Psychotherapy must, then, offer an alternative (to the medical

model) to evaluate psychotherapy services--a better system of

management that is both cost effective and based in the common factors.

Partnership with clients must extend further—to partner with them not

only to make therapy effective, but also to make therapy accountable.

The field must move away from the provision of services that are

“competently delivered” to the provision of services that are outcome

informed, that are effective. Simple, reliable, and valid methods for

assessing client perceptions of progress and satisfaction are readily

available and easily incorporated into any approach to therapy (e.g.,

Outcome Questionnaire 45.2 or the Session Rating Scale; see Duncan &

Miller, 2000a; Johnson & Shaha, 1996; Lambert & Burlingame, 1996;

Ogles, Lambert, & Masters, 1996). Psychotherapists can monitor, with

clients, the session-by session impact in clients’ lives and use that

information both to enhance and prove effectiveness.

Using accepted measures of client perceptions of progress allows

both therapists and payers to know how they’re doing; are they being

effective in capitalizing on the client’s strengths, building

relationships, and helping clients reach their goals? This type of

accountability could challenge the current clinical decision making

process—no more treatment plans, psychiatric diagnoses, lengthy intake

forms, approved therapeutic modalities, or any other practice that

takes up time but fails to improve treatment outcome. More effective

services are cost-effective.

Such a process would also make psychotherapists responsible like

never before. In a therapy directed by client’s perceptions, therapists

are given a chance to be informed about their ability (or lack of

ability) to connect with clients, catalyze client resources, and help

bring about satisfactory outcomes. It is then up to them to either do

 The Dodo Bird 70

more of the same or something different based on what their clients

say. Those who refuse to seek out and listen to client evaluations of

success risk both poor outcomes and the support of a system which now

honors (and pays for) that success. Payment to mental health

professionals could be based on merit, on the ability to work with

clients for successful outcomes.

Moreover, an accountable psychotherapy based in client

perceptions could change standards for training and credentialing of

therapists. In this psychotherapy, the emphasis shifts from the mastery

of techniques to the ability to enter productive relationships and

achieve positive outcomes with clients. Therapist training could be

selected based on routinely gathered and analyzed feedback from

clients. Such a system, dependent as it would be on client self-report

data, would finally give the users of therapy the voice that 40 years

of data say they deserve. At the same time, the client’s voice can

begin to circulate in mental health talk and texts, no longer the

missing link in understanding psychotherapy (Duncan, in press). As a

bonus, an accountability based mental health world could align

professional organizations more around helping therapists gather and

process data from clients and less with partisan interests, turf wars,

and marketplace competition.

Like Scrooge, psychotherapists uncomfortable with the future

vision of our identity have a chance to alter the path that has been

foretold. Changing the forecasted medicalized destiny requires a new

identity for therapists, one that systematically applies the common

factors based in a relational model of client competence. Like Scrooge,

psychotherapists can choose their legacy. We can chose to honor the

wisdom of the dodo bird, or continue to proclaim winners in misguided

 The Dodo Bird 71

attempts to save our place in health care, only to guarantee our second

class status in the medical Borg.

 The Dodo Bird 72

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