Toward delineating some causes of change in psychotherapy.

Many psychotherapists are inclined to give credit to theories and methods that have little to do with the active ingredients of psychological change and growth. They tend to overlook nonintentional influences (biological shifts, environmental changes, the process of maturation, in addition to several other factors) and attribute positive outcomes to specious techniques or cherished "truths" that collapse under scientific scrutiny. Yet there are data on the efficacy of discrete interventions for certain conditions, and despite claims to the contrary, specific therapies have been devised for specific symptoms. But negative effects can also result from psychotherapy. The art and science of effective psychotherapy consist of inspiring hope and achieving self-efficacy in the context of responsible guardianship. The latter implies the implementation of data-based clinical interventions whenever feasible. Fortunately, a concern for facts is replacing religious zeal in most areas of the field. Extreme views have been generated about virtually every position in psychotherapy . Some will argue that relationship factors constitute the essence of psychotherapy and embody all the necessary conditions for growth and change. Others adhere to the view that the elements of hope, faith, and belief comprise the only important factors. Yet others think entirely in terms of tactics, strategies, maneuvers, methods, and techniques. And then there are those who argue that only a comprehensive framework that incorporates all these interactive components into assessment and therapy can possibly delineate the active principles of therapeutic change and eventually lead to a scientific, artistic, and humanistic consensus. Has any clarity come to the fore since Colby (1964) began his review of psychotherapeutic processes with the words "chaos prevails," a sentiment that was echoed by Frank (1971)? If we were to ask a physician for some medical facts or turn to a lawyer for legal facts, we would be inundated with an information blizzard. But when we ask psychotherapists for some psychotherapeutic facts, we often draw a blank. When certain facts are proffered, they usually fall outside the sphere of psychology—for example, "It is a fact that lithium is the treatment of choice when dealing with the manic phase of a bipolar affective disorder." Other people hedge. "What exactly do you mean by 'a fact?' At what level of confidence does something have to be stated before it can be considered factual?" In the past decade, researchers and therapists have come to realize that psychotherapy is not a unitary process applied to unitary problems. General questions about the efficacy of something called psychotherapy (e.g., Eysenck, 1952) have been replaced by an emphasis on specificity: "what treatment, by whom, is most effective for this individual with that specific problem, and under which set of circumstances" (Paul, 1967, p. 111). Yet many noted researchers still persist in conducting omnibus studies. For instance, Luborsky, Singer, & Luborsky (1976) reviewed studies that compared individual psychotherapy with group psychotherapy and examined time-limited versus