SPECIFIC AND NONSPECIFIC FACTORS IN PSYCHOTHERAPY - A CASE OF COGNITIVE THERAPY FOR DEPRESSION

The literature has succeeded in showing that psychotherapy in general is more effective than no-treatment conditions, but it has not clearly demonstrated differences in outcome efficacy between psychotherapies. One prominent explanation for equivalent treatment outcome efficacy i s the Placebo effect. The origins of the placebo effect, its evolution , and the debate surrounding it are discussed. It is argued that the p lacebo effect is not useful for the understanding and advancement of p sychotherapy. It is proposed that examination of specific and nonspeci fic factors with regard to individual therapies will be of more utilit y. Specific factors refer to elements clearly delineated by proponents of a given therapy as the active causes of change. Nonspecific factor s refer to possible elements in one therapy that contribute to improve ment but which are not specified in the theoretical or practical delin eation of the therapy. Cognitive therapy for depression is posited to be a suitable vehicle for examining specific and nonspecific factors i n psychotherapy. Therefore, evidence for specific factors and nonspeci fic factors is considered in the context of Beck's cognitive models an d therapy. The literature appears to suggest that both specific and no nspecific factors are influential. Our own study suggests that specifi c factors are more influential in the change occurring in cognitive th erapy. However, action of these specific factors are not unique to cog nitive therapy. Until evidence is forthcoming to show presence of elem ents both specific and unique to differing psychotherapies, the issue of reasons for treatment efficacy will remain controversial.