Adam Blatner

Efforts to offer research on psychotherapy are worthy, but there is an additional and rather fundamental problem: People range from low to high ego strength, and this variable—more than the severity of their "diagnosis"—that determines prognosis (i.e., the degree of response to a therapeutic intervention or healing). People with a generous number of compensatory skills will do much better with whatever type of therapy. Alas, researchers do not ask such questions, because it messes up the "cleanliness" of research. (Why people tend to believe that research should be clean expresses the simplicity of the human mind!)

Ego strength in turn is a huge category. Another category is family support, or support of friends, the tightness of the community from which the "identified" patient comes. That word "identified" refers to the one with the symptom, because others in the family may be pathogenic and sub-clinically pathological, but not the "patient." It is really more complicated!

Dare I suggest that psychotherapy outcome research reflects the spirit of a question that can be asked—"Does such and such a procedure work?" needs to address the actual complexity of the therapeutic encounter? Might the question applies simplistic criteria to highly complex problems? These are all too readily brushed aside with rationalizations, the main one being "It’s better than not even asking the question" (which is debatable). But in fact, it is better if one acknowledged that there are many variables in play.