Search

Contemporary concerns with “empirically supported treatments” emphasize the differences in outcomes that are associated with reliably delivered treatments, representing different models and theories. This approach often fails to address the fact that there is no consensus among scientists about whether there are enough differences between and among treatments to make this effort productive. There is a considerable body of data that suggests that all treatments produce very similar effects. This article reviews these viewpoints and presents a third position, suggesting that identifying common and differential principles of change may be more productive than focusing on the relative value of different theoretical models. © 2002 Wiley Periodicals, Inc. J Clin Psychol 58: 1199–1212, 2002.

Theoretical literature is contradictory in most areas, but virtually all theories agree on the existence of patient resistance and propose similar implications, meanings, and effects of its manifestation. However, theories differ widely in both the assumed causes of resistance and the methods of dealing with resistant patients. Common to various theoretical definitions is an assumption that resistance is both a dispositional trait and an in-therapy state of oppositional, angry, irritable, and suspicious behaviors. Reactance is a special class of resistance that is manifest in oppositional and uncooperative behavior. Resistance bodes poorly for treatment effectiveness. Nondirective and paradoxical strategies have been found to be quite successful in overcoming resistant and reactant states, while matching low-directive and self-directed treatments with resistant patients circumvents the effects of resistance traits.