Critique on The Heart and Soul of Change
Matthew D. Armstrong
For my critique, I have chosen chapter 3. The title is Clients: The Neglected Common Factor in Psychotherapy. I believe the authors miss a key variable in analyzing human influence in therapy in not considering the impact of personal commitment. The authors also make reference to several studies regarding psychotherapy, but I would question the applicability of these studies to the topic presented. I do not believe that it is possible to analyze all common methods of psychotherapy as if they functioned equally.
The authors make several claims to support the idea of the client being the most important component in therapy. They write, “Wampold’s meta-analysis suggests that about 13% of total outcome variance is explained by treatment (therapist, alliance, model or technique, allegiance, and placebo), leaving 87% of the variance attributed to client or extratherapeutic factors as well as unexplained and error variance.” (p. 84) They also write, “When asked, 90% of individuals polled report having overcome a significant health, emotional, addiction, or lifestyle problem in the prior year.” (p. 85) They most importantly add, “Several studies have shown that 60% or more clients have reported the occurrence of improvement in the period between scheduling and attending their first session.” (p. 86) I admit that these findings are very convincing. The question is: how do we interpret them? I don’t believe that we can conclude that psychotherapy has any less impact or meaning in light of this data. According to Olfson and Marcus (2010), “The percentage of persons using outpatient psychotherapy was 3.37% in 1998 and 3.18% in 2007 (adjusted odds ratio=0.95, 95% CI=0.82-1.09).” This leaves more than 97% of the general population who are not using outpatient psychotherapy. As can be seen, psychotherapy is utilized by a very small minority of people, and the number of...