Jacquelines of All Trades or Masters of Some? Negative Implications of Focusing on Common Factors

Professional social workers are compelled by social work educators, state funding agencies, and their employers to use empirically supported treatments (ESTs). Here an EST refers to a treatment that has met some minimum evidentiary threshold criteria for establishing efficacy (Chambless & Hollon, 1998). Such treatments, however, are only one important part of evidence-based practice (EBP), which refers to an iterative process of selecting the most appropriate interventions that are personalized to diverse social work clients (Gambrill, 2006). Thus, EBP as a process moves well beyond specific evidentiary classification schemes used to deem specific practices to be ESTs. There is a lack of agreement on how to teach ESTs to students (Adams, LeCroy, & Matto, 2009) and implement them with fidelity in today's social services environment in which organizations may lack the capacity, willingness, or resources to do so. As part of this continuing dialogue on how to define EBP, Cameron and Keenan (2010) proposed that social workers perpetuate a transtheoretical common factors approach. Common .factors were defined as the conditions and processes, such as developing empathy or increasing social support, that are known to cut across a "range of practice approaches that have been associated with positive client outcomes" (Cameron & Keenan, 2010, p. 64). Such an approach was argued to have numerous benefits, including the following: allowing social workers to use evidence-based principles while integrating the dizzying amount of practice models available to them, remaining applicable no matter what the population or clinical problem may be, guiding clinical assessments, and moving beyond conceptualizations that place the clinician as the central figure in the helping process. Cameron and Keenan (2010) offered some interesting and useful recommendations for social work educators, practitioners, and researchers. For example, their article reminded us to not become overzealous about any one particular treatment approach, as meta-analytic findings show that change often occurs regardless of what specific treatment techniques are applied (Ahn & Wampold, 2001; Imel, Wampold, Miller, & Fleming, 2008; Wampold et al., 1997). However, not all meta-analyses fail to find differences when comparing distinct active treatments (S. Miller, Wampold, & Varhely, 2008), and when active treatments are compared with carefully constructed control groups including only common factors (that is, attention and rapport development), the former are more effective (Stevens, Hynan, & Allen, 2000). For this and other technical methodological reasons (Carroll & Rounsaville, 2010; Crits-Cristoph, 1997; Shadish & Sweeney, 1991), it remains difficult to conclude that specific treatment components do not matter, and it may be premature to suggest that the widespread adoption of a common factors approach is desirable in social work. This column outlines some potentially negative consequences associated with adopting a common factors model to facilitate additional debate in the profession about defining, teaching, and conducting research on ESTs. COMMON FACTORS APPROACH: EBP ALTERNATIVE OR BUSINESS AS USUAL? Cameron and Keenan (2010) argued that regardless of the specific techniques or specific practice model used, several common factors have empirical support. By extension, no matter what techniques are used to activate these common factors, they should be considered empirically supported because of the literature support for the underlying processes of change that are activated. Although there is merit to Cameron and Keenan's argument that numerous techniques can activate healing processes, caution must be exercised so that using a common factors approach does not become a rationalization for not engaging in the EBP process. For example, many practitioners say they are competent at using effective treatments, but their interventions may not resemble empirically supported or efficient treatment strategies to activate these common factors. …