Going beyond evidence based and common factors approaches: a social constructionist model of therapeutic factors

Abstract

The inception of psychology as a practicing profession in 1938 brought with it a continuing scientific struggle geared towards cementing its place as a value-adding health service in the form of psychotherapy. Concepts such as Empirically Supported Treatments (ESTs), Evidence Based Treatments (EBTs) and Evidence Based Practice in Psychology (EBPP) arose out of research attempts to scientifically prove the efficacy of psychological treatment versus psychiatric medications or versus no treatment. This focus on evidence in psychotherapy partly stems from, but also influences public policy in the form of practice and training mandates as well as government and insurance funding policies for psychotherapy. At present ESTs, EBTs and EBPP are the source of polarisation among psychologists who argue for either sides of this controversy, raising questions on a practical/policy level as well as an epistemological level. This thesis differentiates between ESTs, EBTs and EBPP as well as the Common Factors approach and continues to critically investigate the advantages, practical/policy implications and epistemological critiques against these approaches. Some of the identified shortfalls resulting from unwarranted epistemological (empirical) assumptions are addressed by proposing a social constructionist model of therapeutic factors based on social constructionist- and eco-systemic theories. The proposed model allows therapists to employ EBT’s in conjunction with various other (excluded) approaches that are available in their arsenal of treatments. Clinical case studies are used to illustrate the model’s practical operation in therapeutic contexts.