Cognitive-Behavioral Counseling and Effective Treatment

With any technique, there are a number of variables that affect the clinical outcome.  For example, a practitioner’s level of proficiency in employing a particular technique is a significant variable, as is

the individual’s basic prowess as a counselor.  Add to this the variables that can affect an individual’s ability to respond to counseling, for example, personal expectations of counseling, the propensity for optimism or pessimism, family/community support, etc., and you begin to see how the significance of a particular therapeutic approach can quickly  when considering “what works.”

Scott Miller, Mark Hubble, and Barry Duncan wrote an article entitled, No More Bells, and Whistles (to download a copy, visit http://bit.ly/1INZHhh) that reviews the sources of efficacious counseling.  They suggest that there are “4 common factors” that determine the outcome of counseling: (1) Therapeutic Technique (accounts for 15% of the outcome of counseling), (2) Expectancy and Placebo (15% of outcome) , (3) Therapeutic Relationship (30% of outcome), and (4) Client Factors (40%).  I will skip reviewing each of these 4 “factors,” but suffice it to say that in affecting but 15% of the outcome of counseling, debating the merits of a particular therapeutic approach while stimulating may be more of a footnote in the discussion than than issue of primacy.

It seems to me—and CBT-related techniques and cognitive theory (I always liked George Kelly’s Personal Construct Psychology) are frequently used tools in my counseling toolbox—that IF there were a theory of counseling that truly outperformed all the others, we would at least have a clear indication of its existence by now.  Rather we find practitioners employing various approaches claiming success in their work and the individuals they counseled reporting symptom relief.  This would seem to confirm, albeit unscientifically, what Miller et al. suggest in their article; that it is the therapeutic relationship itself and the individual factors the client brings to therapy that contribute the lion’s share of efficacious outcome in counseling.

There is no doubt that CBT has passed the rigors of scientific scrutiny regarding its efficacy.  What this suggests, to me however, is not so much that it should be used exclusively or even predominantly, but rather that it is deserving of consideration as an evidence-informed, best practice to which our students should be exposed.  So the issue for me is not that CBT is used “too much” or that it has taken on “rock star” status.  The issue is, does CBT—or any other counseling theory for that matter—enable me, as the practitioner, to understand my client’s presenting problem(s) in such as way that I can: (1) design an appropriate treatment strategy to affect symptom relief, (2) assist my client in understanding the nature of the presenting problem and its origin, and do so in such a way that ensures that the client recognizes that she or he has a problem rather than is the problem, and (3) can accomplish this in a reasonable amount of time with non-invasive and cost-effective strategies.

What do you think?

Robert