Hostname: page-component-cd9895bd7-mkpzs Total loading time: 0 Render date: 2024-12-23T08:13:10.109Z Has data issue: false hasContentIssue false
  • English
  • Français

Reconceptualising Exposure and Some Implications for Cognitive-Behavioural and Psychodynamic Practice

Published online by Cambridge University Press:  20 March 2019

David L. Muir Open the ORCID record for David L. Muir [Opens in a new window]  and
Fiona J. Hibberd Open the ORCID record for Fiona J. Hibberd [Opens in a new window]
David L. Muir*
Affiliation:
School of Psychology, University of Sydney, Sydney, New South Wales, Australia
Fiona J. Hibberd
Affiliation:
School of Psychology, University of Sydney, Sydney, New South Wales, Australia
*
*Corresponding author: David L. Muir, School of Psychology, University of SydneyNSW 2006, Australia. Email: [email protected]
Get access

Abstract

The concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.

Keywords

exposureextinction learningtransferenceconceptual analysistherapeutic processes
Type
Standard Paper
Information
Behaviour Change , Volume 36 , Issue 2 , June 2019 , pp. 84 - 101
Copyright
Copyright © The Author(s) 2019 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allen, LB, McHugh, RK and Barlow, DH (2008). Emotional disorders: A unified protocol. In Barlow, DH (Ed.), clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed., pp. 216–249). New York: Guilford Press.Google Scholar
Anderson, J (1938/1962). The problem of causality. In Studies in empirical philosophy (pp. 126–136). Sydney, Australia: Angus & Robertson.Google Scholar
Andersen, SM and Przybylinski, E (2012). Experiments on transference in interpersonal relations: Implications for treatment. Psychotherapy, 49, 370–383. http://dx.doi.org/10.1037/a0029116Google Scholar
Arch, JJ and Craske, MG (2009). First-line treatment: A critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatric Clinics of North America, 32, 525–547. http://dx.doi.org/10.1016/j.psc.2009.05.001Google Scholar
Arkowitz, H and Messer, SB (Eds.). (1984). Psychoanalytic therapy and behaviour therapy: Is integration possible? New York, NY: Plenum Press.Google Scholar
Baardseth, T, Goldberg, S, Pace, B, Wislocki, AP, Frost, ND, Siddiqui, JR …Wampold, BW (2013). Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review, 33, 395–405. http://dx.doi.org/10.1016/j.cpr.2013.01.004Google Scholar
Barkham, M, Stiles, WB and Shapiro, DA (1993). The shape of change in psychotherapy: Longitudinal assessment of personal problems. Journal of Consulting and Clinical Psychology, 61, 667–677.http://dx.doi.org/10.1037/0022-006X.61.4.667Google Scholar
Bechtel, W (2005). The challenge of characterizing operations in the mechanisms underlying behavior. Journal of the Experimental Analysis of Behavior, 84, 313–325.Google Scholar
Bennett, MR and Hacker, PMS (2003). Philosophical foundations of neuroscience. Malden, MA: Blackwell.Google Scholar
Birk, L and Brinkley-Birk, AW (1974). Psychoanalysis and behavior therapy. American Journal of Psychiatry, 131, 499–510.Google Scholar
Borkovec, TD (1997). On the need for a basic science approach to psychotherapy research. Psychological Science, 8, 145–147. http://doi.org/10.1111/j.1467-9280.1997.tb00398.xGoogle Scholar
Borkovec, TD and Castonguay, LG (1998). What is the scientific meaning of empirically supported therapy? Journal of Consulting and Clinical Psychology, 66, 136–142. http://dx.doi.org/10.1037/0022-006X.66.1.136Google Scholar
Borsboom, D, Mellenbergh, GJ and Van Heerden, J (2003). The theoretical status of latent variables. Psychological Review, 110, 203–219. http://dx.doi.org/10.1037/0033-295X.110.2.203Google Scholar
Bouton, ME (2004). Context and behavioral processes in extinction. Learning and Memory, 11, 485–494. http://dx.doi.org/10.1101/lm.78804Google Scholar
Bouton, ME, Westbrook, RF, Corcoran, KA and Maren, S (2006). Contextual and temporal modulation of extinction: behavioral and biological mechanisms. Biological Psychiatry, 60, 352–360.Google Scholar
Bouton, ME and Woods, AM (2008). Extinction: Behavioral mechanisms and their implications. In Menzel, R (Ed.), Learning theory and behaviour. In Byrne, J (Ed.), Learning and memory: A comprehensive reference (vol. 1, pp. 151–172). Oxford: Elsevier.Google Scholar
Carey, TA (2011). Exposure and reorganization: The what and how of effective psychotherapy. Clinical Psychology Review, 31, 236–248. http://dx.doi.org/10.1016/j.cpr.2010.04.004Google Scholar
Castonguay, LG and Beutler, LE (2006). Principles of therapeutic change that work. New York, NY: Oxford University Press.Google Scholar
Chambless, DL and Hollon, SD (1998). Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18. http://dx.doi.org/10.1037/0022-006X.66.1.7Google Scholar
Clarkin, JF, Yeomans, F and Kernberg, OF (2006). Psychotherapy of borderline personality: Focusing on object relations. Washington, DC: American Psychiatric Press.Google Scholar
Cooper, AA, Clifton, EG and Feeny, NC (2017). An empirical review of potential mediators and mechanisms of prolonged exposure therapy. Clinical Psychology Review, 56, 106–121. http://dx.doi.org/10.1016/j.cpr.2017.07.003Google Scholar
Craske, MG (2012). Preface. In Neudeck, P and Wittchen, H-U (Eds.), Exposure therapy: Rethinking the model and refining the method (pp. vii–xii). New York. NY: Springer.Google Scholar
Craske, MG, Treanor, M, Conway, CC, Zbozinek, T and Vervliet, B (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23. http://dx./doi.org/10.1016/j.brat.2014.04.006Google Scholar
Dollard, J and Miller, NE (1950). Personality and psychotherapy. New York, NY: McGraw-Hill.Google Scholar
Doss, BD (2004). Changing the way we study change in psychotherapy. Clinical Psychology: Science and Practice, 11, 368–386. http://doi.org/10.1093/clipsy.bph094Google Scholar
Dreher, AU (2000). Foundations for conceptual research in psychoanalysis. London, UK: Karnac.Google Scholar
Emmelkamp, PMG (2004). Behavior therapy with adults. In Lambert, MJ (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change (pp. 393–446). New York, NY: John Wiley & Sons.Google Scholar
Eysenck, HJ (1979). The conditioning model of neurosis. The Behavioral and Brain Sciences, 2, 155–199. http://doi.org/10.1017/S0140525X00061653Google Scholar
Foa, EB and Kozak, MJ (1986) Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35. http://dx.doi.org/10.1037/0033-2909.99.1.20Google Scholar
Fonagy, P (1989). On the integration of psychoanalysis and cognitive behaviour therapy. British Journal of Psychotherapy, 5, 557–563. http://dx.doi.org/10.1111/j.1752-0118.1989.tb01114.xGoogle Scholar
Freud, S (1912). The dynamics of transference. In Ellman, SJ (Ed.), Freud's technique papers: A contemporary perspective (pp. 35–50). Northvale, NJ: Jason Aronson.Google Scholar
Gelo, OCG and Salvatore, S (2016). A dynamic systems approach to psychotherapy: A metatheoretical framework for explaining psychotherapy change processes. Journal of Counseling Psychology, 63, 379–395. http://dx.doi.org/10.1037/cou0000150Google Scholar
Gipps, RGT (2013). Cognitive behavior therapy: A philosophical appraisal. In Fulford, K, Davies, M, Gipps, R, Graham, G, Sadler, J, Stanghellini, G, and Thorton, T (Eds.), The Oxford handbook of philosophy and psychiatry (pp. 1–24). Oxford, UK: Oxford University Press.Google Scholar
Gipps, RGT (2017). Does the cognitive therapy of depression rest on a mistake? British Journal of Psychiatry Bulletin, 41, 267–271. http://doi.org/10.1192/pb.bp.115.052936Google Scholar
Gabbard, GO (2004). Long-term psychodynamic psychotherapy: A basic text. Washington, DC: American Psychiatric Publishing.Google Scholar
Gabbard, GO and Westen, D (2003). Rethinking therapeutic action. International Journal of Psychoanalysis, 84, 823–841. http://doi.org/10.1516/N4T0-4D5G-NNPL-H7NLGoogle Scholar
Gelso, CJ and Bhatia, A (2012). Crossing theoretical lines: The role and effect of transference in nonanalytic psychotherapies. Psychotherapy, 49, 384–390.Google Scholar
Goldstein, WN and Goldberg, ST (2008). Using the transference in psychotherapy. Lanham, MD: Rowman & Littlefield.Google Scholar
Grillon, C (2008). Models and mechanisms of anxiety: Evidence from startle studies. Psychopharmacology, 199, 421–437. http://doi.org/10.1007/s00213-007-1019-1Google Scholar
Hacker, PMS (2004). The conceptual framework for the investigation of emotions. International Review of Psychiatry, 16, 199–208. http://doi.org/10.1080/09540260400003883Google Scholar
Hacker, PMS (2009). Philosophy: A contribution, not to human knowledge, but to human understanding. Royal Institute of Philosophy Supplement, 65, 129–153. http://doi.org/10.1017/S1358246109990087Google Scholar
Harré, R (2002). Public sources of the personal mind: Social constructionism in context. Theory & Psychology, 12, 611–623.http://doi.org/10.1177/0959354302012005895Google Scholar
Hayes, AM, Laurenceau, J, Feldman, G, Strauss, JL and Cardaciotto, L (2007). Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27, 715–723.http://doi.org/10.1016/j.cpr.2007.01.008Google Scholar
Hibberd, FJ (2014). The metaphysical basis of a process psychology. Journal of Theoretical and Philosophical Psychology, 34, 161–186.http://dx.doi.org/10.1037/a0036242Google Scholar
Hofmann, SG (2008). Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clinical Psychology Review, 28, 200–211. https://doi.org/10.1016/j.cpr.2007.04.009Google Scholar
Hofmann, SG and Smits, JAJ (2008). Cognitive-behavioral therapy for adult anxiety disorders: A meta-analysis of randomized placebo-controlled trials. Journal of Clinical Psychiatry, 69, 621–632.Google Scholar
Høglend, PA (2014). Exploration of the patient-therapist relationship in psychotherapy. The American Journal of Psychiatry, 171, 1056–1066.Google Scholar
Høglend, PA, Amlo, S, Marble, AR, Bøgwald, K-P, Sørb, Ø, Sjaastad, M and Heyerdahl, O (2006). Analysis of the patient-therapist relationship in dynamic psychotherapy: An experimental study of transference interpretations. American Journal of Psychiatry, 163, 1739–1746.Google Scholar
Høglend, P, Bøgwald, K-P, Amlo, S, Marble, A, Ulberg, R … Johansson, P (2008). Transference interpretations in dynamic psychotherapy: Do they really yield sustained effects? American Journal of Psychiatry, 165, 763–771.Google Scholar
Hume, D (1777/1975). Enquiry concerning the human understanding. In Selby-Bigge, LA (Ed.), Enquiries (pp. 5–165). Oxford, UK: Clarendon Press.Google Scholar
Kazdin, AE (2001). Bridging the enormous gaps of theory with therapy research and practice. Journal of Clinical Child Psychology, 30, 59–66. http://dx.doi.org/10.1207/S15374424JCCP3001_7Google Scholar
Kazdin, AE (2007). Mediators and mechanisms of change in psychotherapy research. Annual Review of Clinical Psychology, 3, 1–27. http://doi.org/10.1146/annurev.clinpsy.3.022806.091432Google Scholar
Kazdin, AE (2008). Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63, 146–159. http://doi.org/10.1037/0003-066X.63.3.146Google Scholar
Kazdin, AE (2009). Understanding how and why psychotherapy leads to change. Psychotherapy Research, 19, 418–428. http://dx.doi.org/10.1080/10503300802448899Google Scholar
Klein, M (1932). The psycho-analysis of children. London: Hogarth Press.Google Scholar
Kraemer, S (2006). Something happens: Elements of therapeutic change. Clinical Child Psychology and Psychiatry, 11, 239–248. http://doi.org/10.1177/1359104506061415Google Scholar
Lambert, MJ (2013). The efficacy and effectiveness of psychotherapy. In Lambert, MJ (Ed.), Bergin and Garfield's handbook of psychotherapy and behavior change (6th ed., pp. 169–218). New York, NY: Wiley.Google Scholar
Lane, RD, Ryan, L, Nadel, L and Greenberg, L (2015). Memory reconsolidation, emotional arousal, and the process of change in psychotherapy: New insights from brain science. Behavioral & Brain Sciences, 38, e1. http://doi.org/10.1017/S0140525X14000041Google Scholar
Laska, KM, Gurman, AS and Wampold, BE (2014). Expanding the lens of evidence-based practice in psychotherapy: A common factors perspective. Psychotherapy, 51, 467–481.Google Scholar
Laplanche, J and Pontalis, JB (1973). The language of psycho-analysis (trans. Nicholson-Smith, D). New York, NY: Norton.Google Scholar
Leder, G (2016). Know thyself? Questioning the theoretical foundations of cognitive behavioral therapy. Review of Philosophy and Psychology, 2, 391–410.http://doi.org/10.1007/s13164-016-0308-1Google Scholar
Lemma, A (2003). Introduction to the practice of psychoanalytic psychotherapy. Chichester, UK: Wiley.Google Scholar
Levy, KN and Scala, JW (2012). Transference, transference interpretations, and transference focused psychotherapies. Psychotherapy, 49, 391–403. http://doi.org/10.1037/a0029371Google Scholar
Machado, A and Silva, F (2007). Toward a richer view of the scientific method: The role of conceptual analysis. American Psychologist, 62, 671–681. http://doi.org/10.1037/0003-066X.62.7.671Google Scholar
Machamer, P, Darden, L and Craver, CF (2000). Thinking about mechanisms. Philosophy of Science, 67, 1–25. http://doi.org/10.1086/392759Google Scholar
Mahoney, MJ (1984). Psychoanalysis and behaviourism: The yin and yang of determinism. In Arkowitz, H & Messer, SB (Eds.), Psychoanalytic therapy and behaviour therapy: Is integration possible? (pp. 303–323). New York, NY: Plenum Press.Google Scholar
Mansell, W (2011). Core processes of psychopathology and recovery: ‘Does the Dodo bird effect have wings?’ Clinical Psychology Review, 31,189–192. http://doi.org/10.1016/j.cpr.2010.06.009Google Scholar
Mackie, J (1974). The cement of the universe: A study of causation. Oxford, UK: Clarendon Press.Google Scholar
Maze, JR (1954). Do intervening variables intervene? Psychological Review, 61, 226–234. http://doi.org/10.1037/h0061026Google Scholar
Maze, JR (1983). The meaning of behavior. London, UK: Allen & Unwin.Google Scholar
McWilliams, N (1994). Psychoanalytic diagnosis: Understanding personality structure in the clinical process. New York, NY: The Guilford Press.Google Scholar
Messer, SB (1986). Behavior and psychoanalytic perspectives at therapeutic choice points. American Psychologist, 41, 1261–1272.http://doi.org/10.1037/0003-066X.41.11.1261Google Scholar
Messer, SB (2013). Three mechanisms of change in psychodynamic therapy: Insight, affect, and alliance. Psychotherapy, 50, 408–412.http://doi.org/10.1037/a0032414Google Scholar
Messer, SB and Wampold, BE (2002). Let's face facts: Common factors are more potent than specific therapy ingredients. Clinical Psychology: Science & Practice, 9, 21–25. http://doi.org/10.1093/clipsy.9.1.21Google Scholar
Meuret, AE, Wolitzky-Taylor, KB, Twohig, MP and Craske, MG (2012). Coping skills and exposure therapy in panic disorder and agoraphobia: latest advances and future directions. Behavior Therapy, 43, 271–284. http://doi.org/10.1016/j.beth.2011.08.002Google Scholar
Myers, KM and Davis, M (2002). Behavioral and neural analysis of extinction. Neuron, 36, 567–684. https://doi.org/10.1016/S0896-6273(02)01064-4Google Scholar
Neudeck, P and Wittchen, HU (Eds.). (2012). Exposure therapy: Rethinking the model and refining the method. New York, NY: Springer.Google Scholar
Norcross, JC (1995). Dispelling the Dodo Bird verdict and the exclusivity myth in psychotherapy. Psychotherapy, 32, 500–504.http://doi.org/10.1037/0033-3204.32.3.500Google Scholar
Norton, PJ and Price, EC (2007). A meta-analytic review of adult cognitive-behavioral treatment outcome across the anxiety disorders. Journal of Nervous and Mental Disease, 195, 521–531. http://doi.org/10.1097/01.nmd.0000253843.70149.9aGoogle Scholar
Oelsner, R (2013). Transference and countertransference today. London, UK: Routledge.Google Scholar
Pavlov, IP (1927). Conditioned reflexes: An investigation of the physiological activity of the cerebral cortex. London, UK: Oxford University Press.Google Scholar
Perry, JC (2014). Anomalies and specific functions in the clinical identification of defense mechanisms. Journal of Clinical Psychology, 70, 406–418.http://doi.org/10.1002/jclp.22085Google Scholar
Perry, JC and Bond, M (2017). Addressing defenses in psychotherapy to improve adaptation. Psychoanalytic Inquiry, 37, 153–166.http://doi.org/10.1080/07351690.2017.1285185Google Scholar
Petocz, A (2004). Science, meaning and the scientist-practitioner model of treatment. In Jones, D (Ed.), Working with dangerous people (pp. 25–42). Oxford, UK: Radcliffe Medical Press.Google Scholar
Petocz, A and Newbery, G (2010). On conceptual analysis as the primary qualitative approach to statistics education research in psychology. Statistics Education Research Journal, 9, 123–146.Google Scholar
Pitman, RK and Orr, SP (1986). Test of the conditioning model of neurosis: Differential aversive conditioning of angry and neutral facial expressions in anxiety disorder patients. Journal of Abnormal Psychology, 95, 208–213. http://doi.org/10.1037/0021-843X.95.3.208Google Scholar
Rescorla, RA (1996). Preservation of Pavlovian associations through extinction. Quarterly Journal of Experimental Psychology, 49, 245–258.Google Scholar
Rescorla, RA and Wagner, AR (1972). A theory of Pavlovian conditioning: variations in the effectiveness of reinforcement and non-reinforcement. In Prokasy, AH (Ed.), Classical vonditioning II: Current research and theory (pp. 64–99). New York, NY: Appleton-Century-Croft.Google Scholar
Richard, DC and Lauterbach, D (Eds.). (2007). Handbook of exposure therapies. New York, NY: Academic Press.Google Scholar
Rizvi, SL and Ritschel, LA (2014). Mastering the art of chain analysis in dialectical behavior therapy. Cognitive and Behavioral Practice, 21, 335–349. http://doi.org/10.1016/j.cbpra.2013.09.002Google Scholar
Robbins, SJ (1990). Mechanisms underlying spontaneous recovery in auto-shaping. Journal of Experimental Psychology: Animal Behavior Processes, 16, 235–249. http://doi.org/10.1037/0097-7403.16.3.235Google Scholar
Rodriguez, BI, Craske, MG, Mineka, S and Hladeck, D (1999). Context-specificity of relapse: Effects of therapist and environmental context on return of fear. Behaviour Research and Therapy, 39, 845–862. https://doi.org/10.1016/S0005-7967(98)00106-5Google Scholar
Rosen, GR and Davison, GR (2003). Psychology should list empirically supported principles of change (ESPs) and not credential trademarked therapies or other treatment packages. Behavior Modification, 27, 300–312. http://doi.org/10.1177/0145445503027003003Google Scholar
Rosenthal, R and Rosnow, RL (2008). Essentials of behavioral research: Methods and data analysis (3rd ed.). Boston, MA: McGraw Hill.Google Scholar
Roth, P (2001). Mapping the landscape: Levels of transference interpretation. The International Journal of Psychoanalysis, 82, 533–543.Google Scholar
Ryan, J (2005). How does psychotherapy work? London: Karnac.Google Scholar
Salvatore, S (2011). Psychotherapy research needs theory. Outline for an epistemology of the clinical exchange. Integrative Psychological & Behavioral Science, 45, 366–388. http://doi.org/10.1007/s12124-011-9180-9Google Scholar
Salvatore, S and Tschacher, W (2012). Time dependency of psychotherapeutic exchanges: The contribution of the theory of dynamic systems in analyzing process. Frontiers in Psychology, 3, 253. http://doi.org/10.3389/fpsyg.2012.00253Google Scholar
Schore, A (2011). The right brain implicit self lies at the core of psychoanalysis. Psychoanalytic Dialogues, 21, 75–100. http://doi.org/10.1080/10481885.2011.545329Google Scholar
Shapiro, DA (1995). Finding out how psychotherapies help people change. Psychotherapy Research, 5, 1–21. http://doi.org/10.1080/10503309512331331106Google Scholar
Shedler, J (2010). The efficacy of psychodynamic psychotherapy. American Psychologist, 65, 98–109. http://doi.org/10.1037/a0018378Google Scholar
Steinert, C, Munder, T, Rabung, S, Hoyer, J and Leichsenring, F (2017). Psychodynamic therapy: As efficacious as other empirically supported treatments? A meta-analysis testing equivalence of outcomes. American Journal of Psychiatry, 174, 943–953. http://doi.org/10.1176/appi.ajp.2017.17010057Google Scholar
Tyron, WW (2005). Possible mechanisms for why desensitization and exposure therapy work. Clinical Psychology Review, 25, 67–95. http://doi.org/10.1016/j.cpr.2004.08.005Google Scholar
Tully, S, Wells, A and Morrison, AP (2017). An exploration of the relationship between use of safety-seeking behaviours and psychosis: A systematic review and meta-analysis. Clinical Psychology and Psychotherapy, 24, 1384–1405.Google Scholar
Ulberg, R, Amlo, S, Dahl, HS and Høglend, PA (2017). Does insight mediate treatment and enhance outcome? Psychoanalytic Inquiry, 37, 140–152. http://doi.org/10.1080/07351690.2017.1285184Google Scholar
Valentine, ER (1992). Conceptual issues in psychology. London, UK: Routledge.Google Scholar
Vervliet, B, Craske, MG and Hermans, D (2013). Fear extinction and relapse: State of the art. Annual Review of Clinical Psychology, 9, 215–248. http://doi.org/10.1146/annurev-clinpsy-050212-185542Google Scholar
Wachtel, PL (1977). Psychoanalysis and behavior therapy: Toward an integration. New York, NY: Basic Books.Google Scholar
Wachtel, PL (1980). Investigation and its discontents: Some constraints on progress in psychological research. American Psychologist, 35, 399–408. http://doi.org/10.1037/0003-066X.35.5.399Google Scholar
Wachtel, PL (2007). Relational theory and the practice of psychotherapy. New York, NY: Guilford Press.Google Scholar
Wachtel, PL (2010). Beyond ‘ESTs’: Problematic assumptions in the pursuit of evidence-based practice. Psychoanalytic Psychology, 27, 251–272. http://doi.org/10.1037/a0020532Google Scholar
Wampold, BE, Flückiger, C, Del Re, AC, Yulish, N, Frost, N, Pace, B … Hilsenroth, M (2017). In pursuit of truth: A critical examination of meta-analyses of cognitive behavior therapy. Psychotherapy Research, 27, 14–32. https://doi.org/10.1080/10503307.2016.1249433Google Scholar
Wampold, BE and Imel, ZE (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. Abingdon, UK: Routledge.Google Scholar
Wampold, BE, Mondin, GW, Moody, M, Stich, F, Benson, K and Ahn, H (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, ‘all must have prizes.’ Psychological Bulletin, 122, 203–215. http://doi.org/10.1037/0033-2909.122.3.203Google Scholar
Wells, A (1997). Cognitive therapy of anxiety disorders. Chichester: Wiley.Google Scholar
Wolpe, J (1958). Psychotherapy by reciprocal inhibition. Stanford: Stanford University Press.Google Scholar
Wolpe, J (1981). Behavior therapy versus psychoanalysis: Therapeutic and social implications. American Psychologist, 36, 159–164. http://doi.org/10.1037/0003-066X.36.2.159Google Scholar
Wolpe, J (1995). Reciprocal inhibition: Major agent of behavioral change. In O'Donohue, W and Krasner, L (Eds.), Theories of behavior therapy: Exploring behavior change (pp. 23–57). Washington, DC: American Psychological Association.Google Scholar