Psychotherapy and Eclecticism

To the Editor: In the Practical Psychotherapy column in the March issue Dr. Goin (1) argues for "informed eclecticism … a knowledgeable integration of the several available psychotherapy tools." She contrasts this to "eclectic" psychotherapy, which often turns out to be "a potpourri of different activities, fuzzy and unstructured."

Alas, the latter definition doubtless more accurately describes psychotherapeutic eclecticism in practice. There is good reason for this. The evidence base for psychotherapy depends on carefully defined, manualized treatments that are monitored for therapist adherence. Research generally shows that adherence to one specific model yields better results than a muddied, mixed (read "eclectic") approach (2,3). That treatment purity matters makes sense, particularly in the context of short-term treatments. Therapists should equip patients with a kit of finely honed "tools" for handling symptoms and situations, rather than a hodgepodge of responses.

Moreover, no one is really "knowledgeable" about how best to combine differing treatments. Little evidence is available with which to inform eclecticism. Hence, although mixing techniques is a constant temptation in therapy sessions, it is best avoided. The risk inherent in eclecticism is that therapists will fall into idiosyncratic approaches, as they did in the pre-empirical past. It's important that psychiatric residents be trained in carefully defined treatments (psychodynamic, cognitive, and so forth) so that such eclecticism—a euphemism for entropy—is minimized.

Dr. Markowitz is a research psychiatrist at New York State Psychiatric Institute and clinical professor of psychiatry at Weill Medical College of Cornell University in New York City.