Where is the Dialogue? A Social Constructionist View of Empirically Supported Treatments

Since the publication of the list of empirically supported treatments by the American Psychological Association in 1995 a controversy has resulted between those who view positive psychotherapeutic outcome as resulting from the use of specific (listed) techniques and those who lean towards the so-called common or relationship factors rather than particular techniques as necessary for such outcomes. This paper examines the controversy and shows that both sides follow the same objectivist/empiricist and reductionist epistemology. In contrast, the paper adopts a social constructionist perspective and shows that the idea of therapeutic outcome as linearly determined by either technical or common factors or a combination of these is a misleading oversimplification which fails to account for the dialogue which is the core of psychotherapy. Rather, positive outcome is viewed as mutually constructed in a unique dialogue which encompasses both common and technical factors. This takes the form of the conversational development of a new understanding or reframe of the problem followed by action which is deemed appropriate to the new understanding. This view is illustrated by practical examples.