No Ownership of Common Factors

Abstract

Comments on the original article, "The efficacy of psychodynamic psychotherapy," by J. Shedler (see record 2010-02208-012). Shedler's informative article raised several issues worthy of comment. His choice of the word distinctive (p. 98) in describing aspects of psychodynamic technique is open to at least two interpretations. On the one hand, distinctive can have a qualitative meaning and indicate the presence of a characteristic that is not shared. For example, a sign in the Bronx Zoo distinguishes birds from all other creatures as follows: "If it has feathers it's a bird, if it doesn't, it isn't." On the other hand, distinctive can have a quantitative meaning and indicate that one practice has more of a common element than another practice. Careful reading of Shedler's article and the article by Blagys and Hilsenroth (2000) that forms the basis of the "seven features [that] reliably distinguished psychodynamic therapies from other therapies" (Shedler, 2010, p. 98) shows that Shedler subscribes to the latter, quantitative, definition of distinctive. In other words, the seven features he presented are present in both psychodynamic therapies and the cognitive-behavioral therapies to which he compares them. For example, although Shedler did not mention it, dialectical behavior therapy explicitly focuses on six of the seven features, namely, "focus on affect and expression of emotion," "exploration of attempts to avoid distressing thoughts and feelings," "identification of recurring themes and patterns," "discussion of past experience," "focus on interpersonal relations," and "focus on the therapy relationship" (Shedler, 2010, p. 99). However, in the articles that Blagys and Hilsenroth reviewed, psychodyamic therapists engaged in more of these behaviors than did cognitive-behavioral therapists.

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Correspondence concerning this comment should
be addressed to Michael D. Anestis, Department of
Psychology, Florida State University, Tallahassee,
FL 32306. E-mail: anestis@psy.fsu.edu
DOI: 10.1037/a0021056
No Ownership of Common
Factors
Warren W. Tryon
Fordham University
Georgiana Shick Tryon
The Graduate Center, City University of
New York
Shedler’s (February–March 2010) informa-
tive article “The Efficacy of Psychody-
namic Psychotherapy” raised several issues
worthy of comment. His choice of the word
distinctive (p. 98) in describing aspects of
psychodynamic technique is open to at
least two interpretations. On the one hand,
distinctive can have a qualitative meaning
and indicate the presence of a characteristic
that is not shared. For example, a sign in
the Bronx Zoo distinguishes birds from all
other creatures as follows: “If it has feath-
ers it’s a bird, if it doesn’t, it isn’t.” On the
other hand, distinctive can have a quantita-
tive meaning and indicate that one practice
has more of a common element than an-
other practice. Careful reading of Shedler’s
article and the article by Blagys and
Hilsenroth (2000) that forms the basis of
the “seven features [that] reliably distin-
guished psychodynamic therapies from
other therapies” (Shedler, 2010, p. 98)
shows that Shedler subscribes to the latter,
quantitative, definition of distinctive.In
other words, the seven features he pre-
sented are present in both psychodynamic
therapies and the cognitive-behavioral ther-
apies to which he compares them. For ex-
ample, although Shedler did not mention it,
dialectical behavior therapy explicitly fo-
cuses on six of the seven features, namely,
“focus on affect and expression of emo-
tion,” “exploration of attempts to avoid dis-
tressing thoughts and feelings,” “identifica-
tion of recurring themes and patterns,”
“discussion of past experience,” “focus on
interpersonal relations,” and “focus on the
therapy relationship” (Shedler, 2010, p.
99). However, in the articles that Blagys
and Hilsenroth reviewed, psychodyamic
therapists engaged in more of these behav-
iors than did cognitive-behavioral thera-
pists.These six features appear to us to ex-
emplify common factors that are as basic to
good psychotherapy as are Rogerian skills.
Indeed, any therapist, regardless of orien-
tation, who can engage and retain clients
for up to 40 hours, which Shedler (2010)
defined as short term, will necessarily have
to address most, if not all, of these thera-
peutic elements. Although these features
may have originated in the psychodynamic
literature, they transcended their origins
and became pantheoretical more than 30
years ago. As Bordin (1979), uncited by
Shedler, indicated in his seminal article on
working alliance, “The terms of the thera-
peutic working alliance have their origin in
psychoanalytic theory, but can be stated in
forms generalizable to all psychotherapies”
(p. 259). In the section titled “A Rose by
Another Name: Psychodynamic Process in
Other Therapies,” Shedler (2010, p. 103)
acknowledged but did not explicitly recog-
nize that six of his seven “distinctive” fea-
tures are common factors. To imply that
these factors are qualitatively unique to
psychodynamic and psychoanalytic tech-
niques is regressive. There is no ownership
of common factors. Shedler’s (2010) arti-
cle should have been titled “Common Fac-
tors of Effective Interventions,” in which
case the section titled “How Effective is
Psychotherapy in General?” (p. 100) could
have been expanded to include the empir-
ical evidence he presented regarding the
effectiveness of modern common-factor-
based psychodynamic therapy.
Shedler (2010) opined, “Undergradu-
ate textbooks too often equate psychoana-
lytic or psychodynamic therapies with
some of the more outlandish and inacces-
sible speculations made by Sigmund
Freud” (p. 98). Although neither Shedler
(2010) nor the several references he cited
itemized these distinctive psychodynamic
speculations, several come to mind: penis
envy; Oedipus and Electra complexes; cas-
tration anxiety; the urethral, phallic, oral,
and anal characters; along with nasal reflex
neurosis and birth anxiety. If psychology
textbooks have focused on these con-
structs, perhaps it is because they are so
qualitatively distinctive. We agree with
Shedler (2010) that such topics no longer
deserve psychologists’ attention or, hope-
fully, inform their clinical practice. We rec-
ommend focusing on what we share in
common as a way to move our field and
profession forward, and we thank Shedler
(2010) for calling attention to often uncited
sources of empirical support for common
practices.
One can view positive treatment out-
comes as validating the theoretical bases on
which therapies are constructed. However,
as Shedler (2010) himself pointed out, one
can also be right for the wrong reasons:
“The ‘active ingredients’ of therapy are not
necessarily those presumed by the theory
or treatment model” (p. 103). Sometimes
treatments work for reasons other than
those postulated by their authors and pro-
ponents. The efficacy of common-factor
interventions supports more than psy-
chodynamic theory. However, Shedler’s
(2010) focus on symptom reduction as
valid outcome evidence regarding the em-
pirical effectiveness of psychodynamic and
psychoanalytic interventions is a huge de-
parture from the psychodynamic theory of
psychopathology and symptom formula-
tion, which requires symptom substitution
when underlying conflicts are not fully re-
solved. Tryon (2008) demonstrated that the
past half century has yet to reveal any
credible evidence of symptom substitution
despite thousands of symptom-oriented
151February–March 2011 ●American Psychologist
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