AUTORIDADES PÚBLICAS

The different psychotherapy "schools" continue to make claims to superior results, in spite of evidence for equal effectiveness of the therapies. Leventhal & Shemberg (1977) present a rationale for the co-existence of equally effective contradictory theories. Conceptual systems are developed and taught to trainees in order to provide security for beginners, to satisfy an essential 'need to

know' on the part of both patient and therapist, and to provide a common language to enable communication between therapists. As the therapist becomes experienced within his/her framework, a set of personal actuarial tables are developed empirically which refer to a stock of effective therapeutic operations, often theoretically inconsistent, for specific patient behaviours that produce specific outcomes. What is needed, in view of the limited mental storage space of individuals, is a "good cookbook" (Meehl, 1956), which would provide a compilation of theories that are "close to the data" and possibly of help eventually in developing an overarching theory. The "cookbook" approach as practised by the "manualized" supervision technique needs to be tested and compared to personalized supervision.

By the mid-1980s, a new Zeitgeist of eclecticism has appeared, with a tendency away from the established orthodoxies and toward therapies that synthesize a variety of orientations. Pre-viewing this, Garfield and Kuntz (1977) noted a wide variety of theoretical combinations in eclectic approaches, uniting psycho-analysis, learning theory, neo-Freudian, Rogerian, humanistic, cognitive, etc., in a kaleidoscope of differing ways. The movement toward eclecticism has brought about an even greater difficulty in evaluative, systematic research into "effective ingredients". Although there are continued attempts to identify variables that play a role across all

the therapies, such as one by Garfield (1980) which cites as "common factors" those of relationship, expression of emotion, support, explanation and interpretation, advice, suggestion and facing anxiety-provoking stimuli, the research dilemma persists. Its solution calls for a new approach and points toward the study of psychotherapists who consistently are successful in treating their patients and, ultimately, toward selection, training, and quality control in the psychotherapy training institutions. The crucial issue for the future of psychotherapy research is stated by Lambert, Shapiro & Bergin (1986): "As standards of therapist selection and training continue to improve, and as well-trained therapists are included more frequently in research studies, we can expect average effect sizes to improve" (p.3o).

SUMMARY

Since the founding of psychoanalysis in the early years of this century (Freud, 1910), the psychotherapy movement has experienced steady growth and widespread recognition as a treatment for psychological disorder and emotional distress, although research evidence for its efficacy has lagged far behind its practice. Alongside the development of the psychoanalytically-oriented psychotherapies, the science of behaviour modification has evolved (Watson, 1913; Skinner, 1938), providing alternative

procedures for alleviation of distress and behaviour change. Cognitive therapy has grown out of behaviourism and has made a theoretical rapprochement to the more purely psychological psychotherapies (Bandura, 1969). A third movement, humanist-existential therapy (Binswanger, 1956; Boss, 1963; Rogers, 1951) has arisen and, along with the rapidly growing field of counselling, offer other treatment approaches.

Eysenck (1953), from the background of well-tested behavioural theories, made a forceful attack on the efficacy of psychotherapy that stimulated a period of research into comparative outcome studies of the therapies. No clear differences between the therapies emerged from the research, with the psychotherapies performing as well as the cognitive and behaviour therapies (Luborsky, Singer & Luborsky, 1975; Smith, Glass & Miller, 1980), but by 1980 a consensus was reached that psychotherapy as a phenomenon did exist and as a generic treatment has been found to be demonstrably more effective that no treatment (Bergin & Lambert, 1978; Shapiro & Shapiro, 1982).

Research interest moved toward the discovery of what the phenomenon consists, the identification of the process and content elements associated with good outcome (Stiles, Shapiro & Elliott, 1986). Although technical and mechanical processes emerged from these numerous studies as linked with good outcome, they appeared no more decisive than therapy type in determining therapeutic success. It

did emerge, however, that a group of therapist factors were highly effective. These can be described as therapist skilfullness, therapeutic bond, therapist engagement and empathie resonance, along with moments of insight, relief and conflict resolution (Orlinsky & Howard, 1986). This emphasis on therapist factors has been confirmed by the finding that some therapists are consistently more successful than others, leading to research into ’therapist-by-therapist' outcomes, and the finding that therapist effects are larger than treatment types or technique differences (Orlinsky & Howard, 1980; Luborsky, McClellan, Woody, O'Brien & Auerbach, 1985; Crits- Christoph, Luborsky, McClellan, Woody, Piper, Liberman & Umber, 1985). This shift in research focus from group effects to therapist effects suggests a more complex model for psychotherapy research (Lambert, Shapiro & Bergin, 1986) and points in the direction of skill acquisition and training issues.

The importance of a meaningful interpersonal therapeutic relationship has gained parity with technical skill for successful psychotherapy and it has been stressed that training programs should emphasize both (Lambert, Shapiro & Bergin, 1986). The recognition of therapist factors along with a new climate of eclecticism (Garfield & Kuntz, 1977) has brought about an even greater difficulty in evaluative, systematic research into "effective ingredients" and calls for a new approach in psychotherapy

research. Inquiry into the training of good psychotherapists through the study of supervision provides just such a new avenue and the following chapter will examine the research issues in this field.