What is the placebo in psychotherapy?

Although there is an extensive literature on the placebo effect in psychotherapy, the distinction between the placebo and other elements of the therapeutic process has not been clear. This paper analyzes the therapeutic relationship in terms of separating the placebo elements and the specific actors. The so-called nonspecific elements, often equated with the placebo, are proposed as the specific factors. It is contended that those variables focused upon by those studying the social psychological factors are actually part of the placebo. Nearly twenty-five years ago I titled a chapter in Counseling and Psychotherapy: Theory and Practice (Patterson, 1959) Common Elements in Psychotherapy: Essence or Placebo? At that time I suggested a division of the common elements in all psychotherapies into those which were essentially specific treatment variables and those which were essentially placebos. In the first edition of Theories of Counseling and Psychotherapy (Patterson, 1966) the suggestion was repeated. The suggestion has been ignored in the literature on psychotherapy and the placebo effect. In this paper I shall develop this suggestion further, in the light of more recent discussions of the psychotherapy relationship, particularly the attention to social psychological variables.