Common Factors, 4e, and Contemplation

Introduction

There's good reason to believe that a counselor's best tool for becoming more effective is rooted in a project of self-growth toward authentic, genuine engagement with the world. This fluffy, idealistic belief derives from two prominent critiques, which I discuss below: The Common Factors[1] model of psychotherapy, and the Embodied approach[2] to cognitive science. Both react to lines of research which (purposely or incidentally) ignore the qualities and components of human experience as valuable research methods. Taken together, I believe that these approaches hint toward a shift in how we conceptualize, operationalize, intervene with, and study human experience.

Holism vs reductionism in 21st century mental health care

20th century mental health care research tended to reduce the messy, complex process of psychotherapy into "manualized therapies." This was pursued in an attempt to prove the adequacy of applied psychology as a legitimate science. "Manualized" is important, as it "allowed" for us therapy researchers to utilize the "gold-standard" of medical science research: the Randomized Control Trial. However, contemporary psychotherapy researchers[3] have criticized our assumption that we counselors can (and should?) readily use medical research methods to investigate our role as helpers and healers. Instead, they ask: Given the body of research showing that most therapies work equally well, what if we looked at the factors that are common across these therapies?

This approach—known as the Common Factors approach, or the Contextual Model of psychotherapy—is most systematically presented in Bruce Wampold's The Great Psychotherapy Debate: The Evidence for What Makes Psychotherapy Work. This book calls for changing our philosophical assumptions in researching psychotherapy outcomes; professionally, it asks practitioners to give more focus to the factors which are common to effective psychotherapy. These factors include the therapeutic alliance, the characteristics and extratherapeutic variables of the client, and the characteristics of the therapist.

"There are a number of trials that compare a coherent, cogent, structured treatment to what’s often called “supportive therapy,” where the patient just sits with an empathic therapist, but there’s no treatment plan, there’s no explanation to the patient about what they’re going to do in therapy to help them get better... [They] are a lot more effective than doing nothing, but they’re not as effective for targeted outcomes as those that have a coherent explanation and treatment plan. As long as what they’re doing is believable, accepted, is given by a therapist who’s skilled and believes in the treatment as well, the treatment tends to go well."

- from "Bruce Wampold on What Actually Makes Us Good Therapists" (source)

So, rather than investigating "what therapies work, for what type of client, with what type of illness," we would instead focus on "what are the factors that promote positive change" (and I would personally add: "as identified and defined by the client/'s worldview'"). In this case, targeted outcomes and coherent explanations would be identified as core "factors that promote positive change."

I believe the Common Factors approach suggests an alternative paradigm for counseling research which foregrounds the place of the therapist and client as agents of change, rather than a passive administrator (therapist) and recipient (client) of a specific intervention.

When looking across psychological disciplines, as in the arguably "harder" science of cognition, approaches like those posed by embodied cognition lead us think critically about the inescapable circularity of the researcher studying experience—not as a trap, but as a method of cyclically generating first-person knowledge.

The Embodied Mind and inescapable circularity

When attempting to study and intervene with human experience, there is an inevitable circularity that we cannot escape—though our science of mind (and therapeutic change) has desperately tried. The Embodied Mind: Cognitive Science and Human Experience speaks directly to this circularity in cognitive science research.

Without diving too deep, the approach of embodied and enactive cognition is a reaction to the dominant cognitive science program, which (they claim) is more reductive. This approach argues that the context of the research, as well as immediate first-person experience, is invaluable in conceptualizing and studying cognition. In other words, rather than conceiving of cognition as simply "happening in the brain," embodied cognition seeks to capture a more complete picture—all the way up to the experience of the researcher conceptualizing cognition and its context/background. The book describes this well:

There is a reductive tension in cognitive science that isn't as present in the study of psychotherapy outcomes—but it is present, nevertheless. I highlight this in a critique of Ben Caldwell's (superbly wonderful and highly recommended) Saving Psychotherapy, which seeks to present neuroscientific explanation[5] as the most legitimate form of scientific research which practitioners can utilize to prove that "therapy works." Pragmatically, I have doubts that this level of explanation is the most appropriate for clinicians.

Specifically, I have wondered whether our status as a fledgling "social science" (with all the "softness" that the term implies) has led to similar reductionist tendencies in our psychotherapy and counseling research. In cognitive science, the tendency is to reduce to atomistic understandings of cognition happening in the brain; in psychotherapy research, the tendency is to reduce the outcomes to the specific intervention used. Both forget, neglect, and discard the experiences of the humans in the room. True, "experience" is incredibly complex, and our understanding of mind/consciousness is nascent and tenuous despite the centuries of philosophizing behind it. Yet, in reflecting on and integrating our experience into research, I believe we broaden the capacities of our science (as in embodied cognition) and our ability to be more effective as practitioners (as in the contextual model).

What does this have to do with counselors?

If we took this "stuff" (i.e., the validity and utility of human experience within our research programs and professional development) seriously, our professional institutions would look radically different.

We would probably eliminate both comprehensive and licensing exams (which already exclude POC, anyways) as measures of competency.[6] We would stop comparing this intervention to that intervention, and instead throw more time and money at conceptualizing, operationalizing, and studying the common factors more intensively. Finally, we would overhaul our educational curricula to stop emphasizing theory and rote knowledge acquisition, and instead prioritize skills and experience and reflection—and the essential component of the professional's personal growth in this entire project.

This is the lifeblood of the connection between counseling and contemplation that animates this blog.

The Contemplative Counselor

My ongoing project is to sketch a roadmap for contemplation in counseling. This is inspired by the interdisciplinary work being undertaken in the nascent field of Contemplative Studies, which encompasses both the Contemplative Sciences (including the approach in The Embodied Mind, which features Buddhist contemplative practices as methods for cognitive scientists) and also Contemplative Pedagogy.

For counselors,[7] I believe contemplative practices are useful because they:

• are a vital source of relief amidst the sometimes immense and inescapable suffering that our clients experience;
• transfer to concrete, transtheoretical counseling skills (such as empathy, presence, etc.);
• provide clinicians with potential contemplative, spiritual interventions for their clients, and;
• foreground the fact that counselors and their clients are in a dynamic, fluctuating healing relationship that cannot simply be reduced to any single intervention or modality, including contemplation, itself.

For these reasons, I think the critical self reflection (sometimes called "critical subjectivity) fostered by contemplative practices fits well into any conversation about changing psychotherapy and counseling research paradigms. This blog is to help me work through these ideas, to interrogate the utility of these points through the lenses of history, philosophy, professionalization, and practicality.

Footnotes