In searching for articles for the Historical Archive of this issue of Psychomed, we found a volume from 1984, entitled Cognitive psychotherapies: recent developments in theory, research and practice (Ballinger Ed., Cambridge, MA), edited by M. A. Reda and Michael J. Mahoney, which presents a broad overview of the issues debated in psychotherapy 40 years ago.
With a bit of nostalgia we saw in the index of this book the names of dear colleagues who are no longer with us, Vittorio Guidano, Michael Mahoney, Giovanni Liotti and Bruno Bara. And we remembered that in 1984 we were as Visiting Professors at Stanford (CA) and later with Michael Mahoney when he moved to Santa Barbara in a beautiful University on the California coast.
The feeling was that of a very distant time, still a bit pioneering for behavioral psychotherapies and the then more recent cognitive therapies. However, the content of the book chapters did not seem obsolete to us, indeed the topics covered are still current and still debated. Just to give a few examples, the processes of change (M. Mahoney), knowledge and mnemonic processes (B. Bara) or the cognitive effects of pharmacotherapy (M. Reda).
Even the theme of our chapter on the differences between the most practiced psychotherapies at the time, written together with G. Marchetti and entitled Psychoanalysts, Behavior Therapists, and Cognitive Therapists, A Comparative Analysis of Personal Constructs, it seemed to us still within a current debate and was therefore selected for the Historical Archive of this issue of the Journal.
Examining the merits of the research study here described, which investigates the conceptual models of psychotherapists of the three main approaches (behavioral, cognitive and psychodynamic), the results obviously reflect the cultural panorama of that period. As expected, the constructs related to the medical model were more represented among psychoanalysts than among behaviorists and cognitivists (with p<0.05), while psychological and social constructs were less present among psychoanalysts than among the other two groups (with p<0.05). Furthermore, as expected, the “emotional” constructs were more widespread among psychoanalysts, while the cognitive and behavioral ones were more widespread in the homonymous groups.
Considering the data in an aggregate manner, Mahoney’s hypothesis that the behavioral and cognitive approaches showed differences only on a limited number of themes was more supported, in contrast with the hypotheses of other authors (Liotti and Reda, 1981[1]), who saw profound epistemological differences between the two approaches.
What would we find if we would replicate the same research today?
Trying to imagine the results, we could hypothesize that the medical model has maintained its importance even if accompanied by psychological and social “dimensions”, particularly in the psychodynamic field, while it has further decreased its weight in the cognitive and behavioral context, given the progressive affirmation of the trans-diagnostic approach. It is also predictable that attention to emotional aspects has greatly increased in the cognitive and behavioral field, as indicated by the enormous multiplication of studies on emotional self-regulation, particularly in the trans-diagnostic perspective.
As for M. Mahoney’s hypothesis on the differences considered non-substantial between cognitivists and behaviorists, this seems to us to be currently verified in practice, where, despite the notable proliferation of orientations with different names and reference theories, they are often grouped under the common denomination “cognitive-behavioral”.
Finally, it is also likely that, given all the cultural exchanges that have occurred in this long period, an “osmosis” has occurred and that therefore the differences between the three types of therapies have in fact diminished.
What is desirable for the future?
In our opinion, it would be useful if the results of basic and clinical research were to guide therapeutic models and not only the reference theories.
From our research within the CLP Project (Common Language in Psychotherapy Procedures [2]), there would appear to be a limited number of “active ingredients” common to the procedures of the different psychotherapeutic orientations ([3]), as well as common non-specific components, such as the therapeutic relationship ([4]), the placebo effect ([5],[6])/nocebo effect ([7]) or others of a procedural nature (1).
Beyond the different approaches, it could be useful to highlight the effective components of psychotherapeutic procedures in order to have operational indications on which interventions may be clinically more suitable in relation to the dysfunctions targeted in the clinical evaluation (trans-diagnostic formulation of the clinical case [8]).
In this way, purely theoretical contrasts would be avoided and the conditions would be created for the clinical verification of the effectiveness of psychotherapeutic interventions and for the study of the processes of change during the therapies.
Stefania Borgo & Lucio Sibilia
[1]Liotti G. & Reda M. (1981). Some epistemological remarks on behavior therapy, cognitive therapy and psychoanalysis, Cognitive Therapy and Research, Volume 5, pages 231–236
[2]https://www.crpitalia.it/wp-content/uploads/2018/12/CLP_101.pdf
[3]Sibilia L., Borgo S., Marks I., Tortella-Feliu M. & Sungur M. Z.(2021) https://www.researchgate.net/publication/357403608_Classifying_what_psychotherapists_do_A_third_step
[4]Sibilia L. (1994) An Etho-cognitive analysis of patient-therapist relationship. In The Patient-Therapist Relationship: its Many Dimensions, a cura di Borgo S. & Sibilia L. Roma: CNR.
[5] Borgo S. (2015) Terapia placebo. In Borgo S., Sibilia L. & Marks I. (2015) Dizionario clinico di Psicoterapia, Roma: Alpes Italia.
[6]Borgo S. & Sibilia L. (2014) Placebo: effetto e terapia, Idee in Psicoterapia, 1, 67-75.
[7]Borgo S. (2024) L’effetto Nocebo [The Nocebo Effect]. Il Cesalpino, Approfondimenti specialistici. n. 61
[8]Borgo S. (2019). Le disfunzioni trans-diagnostiche cognitive, comportamentali ed emotive, Psychomed, n° 1-3, pp. 35-46.
Stefania Borgo
