Remember me
If you spend time looking at frameworks in the therapy/meditation/self-help space, you’ll soon find lots of conflicting claims about The One Approach for solving your problems.
In the therapy space, there are lots of models that say something like “all emotional problems are caused by trauma/suppressed negative emotions”. Then they disagree about how to deal with it.
Internal Family Systems (IFS) therapy holds that you should always move toward the suppressed material cautiously, explicitly checking in with all of the mind’s existing defenses to make sure that it’s okay to proceed. When you reach it, you should work with it in an “unblended” form, where you can witness the memory from the outside and offer it comfort and safety. For instance, if your parents used to yell at you, you can see yourself as a child whose parents were yelling at them, and then step in as an adult who comes to comfort that child and tell them that they’re okay.
Meanwhile, some psychedelic therapies essentially operate by temporarily blowing up all the defenses and throwing you right inside the original trauma. For instance, you might drink ayahuasca and viscerally feel the nausea and agony of having your parents yell at you, and then experience that trauma literally leaving your body as you throw it up. People in these kinds of circles might tell you that while the experience is horrible, it’s the only way to get to the root of things.
Some of the trauma-focused therapies say that it is crucial to develop an improved understanding of what the original trauma was and what it meant, to correct any incorrect beliefs it caused you to acquire. For instance, maybe you will go from “my parents always yelled at me because I was uniquely bad” to “my parents always yelled at me because they were under a lot of stress and didn’t have the resources to deal with it better than that”.
Others say that you don’t necessarily even need to understand what the trauma was - it’s enough to release the negative emotions associated with it. For instance, if the belief “I’m uniquely bad” involves a bodily feeling of nausea, you can find a way to release the nausea and stop feeling it. Then the belief becomes just an arbitrary sentence in your head that will no longer feel compelling.
Meanwhile, something closer to Cognitive Behavioral Therapy (CBT) might think that what matters are cognitive distortions operating in the present. It might hold that if you say “I’m uniquely bad so everything I do will fail”, then that’s a combination of labeling (turning your past failures into an identity claim) and overgeneralization (thinking that you fail at everything because you’ve failed at some things). It might then recommend something like tracking your actual successes and failures in order to notice that the belief isn’t true.
Also meanwhile, a solution-focused therapy might do none of this and just ask a question like “what’s a time when you felt more optimistic about succeeding at things”, and get you to remember times when you weren’t so burdened by your pessimistic beliefs. Maybe there was a time when you were in a group of people who were all excited and enthusiastic about something, and that got you so psyched up that you forgot all about your pessimism. Then what actually matters is surrounding yourself with the right people.
And while we are on the topic of external fixes, you will also find people saying that
Actually, your problems are all caused by issues with your nutritionActually, your problems are all caused by insufficient exercise (“just lift, bro”)Actually, your problems are all fixable with the right medicationAdditionally, some meditation teachers will tell you that all of this is targeting the wrong things. You are only experiencing all of this as a serious problem because your mind has incorrect beliefs about what it is, and how tanha[1] causes you unnecessary suffering. The key is doing something like vipassana practice to get your mind to see what’s really going on, so that it will let go of the processes where it repeatedly hurts itself. Then both feeling bad about yourself and failing to achieve anything because of that turn into just sensations that you can witness without feeling hurt by them.
Obviously not all of these can be simultaneously true, so why do people believe that they are?
There is an obvious cynical explanation - “because that helps them sell their method better”. That is no doubt sometimes the case, but lots of these people seem sincere in their belief.
I think that for each of these approaches, there’s some particular shape of problem that the given approach really is either the best one or just very good for. You are only going to treat nutrient deficiency by fixing your diet; you are only going to solve low-level tanha by training your mind to closely observe it; some kind of trauma processing is good for PTSD. They also make different choices when it comes to values - something like the Internal Family Systems approach of dealing with trauma very cautiously is less risky and less unpleasant for the client than a system that throws the person right inside the trauma.
I have a more detailed model of psychology that tries to reconcile all of these into a single framework, but for this post, the main implication of it is just “minds are complicated and so are people’s issues; some issues need a specific approach while others can be affected by several”.
Issues in conventional medicine are similar. If you have a bacterial infection, you’ll just want to take an antibiotic. Meanwhile, high blood pressure can have multiple causes and also multiple interventions: getting more exercise, reducing one’s sodium intake, lowering stress, losing weight, taking one of various drugs, etc.
Likewise in mental health, a phobia with a clear specific target (like dogs or spiders) tends to respond well to exposure therapy. While depression may have various causes and contributing factors from biological to situational, and also many different interventions: antidepressants, different kinds of therapy, exercise, material improvements to one’s situation, social connection, sleep adjustment, etc.
This means that each individual framework can sometimes be either the one for a particular kind of problem, or it might be sufficiently general (like “get more exercise” is for health) that it makes sense for people to promote it in particular. Or, it might just happen to make a particular set of tradeoffs that happen to work especially well for some people, analogous to how ways of reducing blood pressure vary in how feasible they are to different people.
I’ll say more about that later, because I first need to deal with one obvious objection.
What I’ve said holds that different kinds of therapies and spiritual practices will have different effects and mechanisms of action, which is a more disputed claim. In particular, there is the well-known “Dodo bird verdict”, which holds that all therapies are roughly equally effective. Related, common factors theory holds that therapy effectiveness is mostly explained by things like the degree of empathy and therapeutic alliance in the process, rather than by the details of the approach.
So why do I hold my model?
It’s first worth noting that the “common factors are all that matters” interpretation is by itself pretty extreme. A 2017 review paper[2] recounts that
A highly cited 2002 review of 17 meta-analyses comparing active treatments with each other showed small, non-significant differences in outcome, which diminished further after the substantial effects of researcher allegiance were controlled for. However, these and similar findings have been questioned by those of other meta-analyses. Tolin, for example, reported that CBT was associated with a significant advantage over other therapies, at least in patients with anxiety or depressive disorders. Similarly, Hofmann and colleagues showed evidence for treatment specificity in a review of 269 meta-analytic studies examining CBT for different psychological problems. [...]
The common factor and specific factor positions might be less divergent than they at first appear. First, most specific-factor theorists concede that common factors are important. [...]
Second, common factor theorists seem to be increasingly tightening their definition of bona fide therapy. They suggest that the treatments must be delivered by trained therapists, based on psychological principles, and credible to the patients receiving them.
Third, most common factor theorists concede that some specific techniques are more effective than others for particular conditions. A major concession is that exposure-based procedures could be necessary for some types of anxiety disorders, although how exposure is performed might not matter. Both camps acknowledge that moderator factors, such as age, could be important [...] Other examples for which there is broad agreement for problem-specific effects include treatments for severe motor tics or cognitive deficits in schizophrenia.
There are also various methodological problems with running randomized controlled trials on therapy, which that same review discusses. So it’s not quite the case that the Dodo bird verdict would be the scientific consensus: rather its validity and scope is still an open question, and there is rough agreement that at least some interventions do work better on some cases than others.
Those aren’t the main reasons for why I have my own complex model of what’s going on, though.
My main reason is just that I’ve done various forms of therapy, meditation, and self-help, and they seem to clearly have different effects and work in different ways. Recognizing something as a cognitive distortion à la CBT, healing an exile à la IFS, or seeing subtle tanha à la insight practice are very different kinds of experiences, cognitively and emotionally. And while introspection isn’t a reliable guide to what’s happening in the brain, for me to believe in “these are all secretly the same” would be getting into “maybe there’s an evil demon messing with my mind and rewriting all of my experience according to its whims” territory.
When I got - after significant initial skepticism - into Internal Family Systems therapy and got training in it, I found it personally valuable and then started facilitating it to friends who were interested. Some it didn’t do much for, but some would say things like “this one session felt more useful than all my previous experiences with therapists combined”. That encouraged me to start doing IFS-based emotional coaching, where the results have been similarly varied.
Some of my clients get very little benefit from IFS, some quite a bit, and then occasionally there are ones who’ll show up for just a few sessions and find their life so drastically improved that they don’t feel a need to come back. I had one client who felt stuck in their life, had about three sessions with me, and then a year later e-mailed me to share a list of significant achievements and life improvements that had happened since then that they attributed to our work - when none of the previous therapists and coaches they’d worked with had felt helpful, and they’d previously felt skeptical of the possibility of ‘discrete step’ progress.
This kind of an outcome is definitely not the median outcome, but it’s also sufficiently common that I’m not surprised by it. And yes, there is regression to the mean and people do sometimes improve spontaneously… but it doesn’t really feel plausible to me that a client would have the experience of a breakthrough session and then just totally coincidentally happen to improve just then on something they’ve been struggling with for years. Maybe if I was seeing a hundred clients per year, you might expect something like that to happen by pure chance, but “some dozens” on a busy year is more accurate. And I’ve usually gotten a few of these per year.[3]
Notably, “some clients benefit a lot, some not at all, and the rest are in between” is entirely compatible with the Dodo bird verdict. If you take an average of the effect over all clients, you’d probably get something like “IFS works roughly the same as every other therapy”. (Indeed, the small number of randomized studies we do have on IFS say that it works roughly as well as whatever it is being compared with.) Standard parallel-group RCTs cannot estimate the extent to which any given person would have responded better to another treatment, because people are randomized into only one treatment arm.
The simplest explanation to me would be that for whatever reason, some interventions just work better on some people than others, in ways that are related to how their individual psychology works.
You might notice that I’m treating “specific interventions work best on specific issues” and “specific interventions work best on specific people” somewhat interchangeably. I started by suggesting that - say - IFS works best on particular kinds of problems, but now I’m talking about what kinds of people IFS works best for.
This is because I think these can’t always be cleanly distinguished. The review that I quoted above mentioned a finding that Acceptance and Commitment Therapy might be better than CBT for older adults with chronic pain, “perhaps because the therapeutic focus was more aligned with learning to live well with pain, rather than the treatment being expected to reduce the pain.” I didn’t want to cite this as evidence because the empirical evidence for it looked very weak at this stage, but let’s consider what it would mean if this was true.
The review called this a “moderator factor” for the general issue of chronic pain. But it seems slightly questionable to me whether the kind of permanent chronic pain that you might get from living to an old age should be considered the “same” issue as chronic pain you’re expected to eventually recover from! Your orientation to something you think might go away and something that you expect to just worsen is entirely different.
Likewise, people vary quite a bit in how they think and process the world. Some people have a constant internal monologue narrating everything that happens to them, and that have an “inner critic” in the form of a voice that is literally criticizing them and saying bad things about them. This is totally alien to me: unless I’m thinking about what to say in conversation or what to say in an essay like this one, most of my thinking is non-verbal and non-linguistic. My inner criticism doesn’t feel like anyone saying bad things about me, it just feels like I’m intrinsically bad.
Now suppose that I have a friend who does have an active inner monologue and a voice-like inner critic. If both me and my friend are feeling bad about something we’ve done, then on one level we’re having the same issue, but at the same time the form that the issue takes is entirely different. A therapeutic intervention along the lines of “ask the voice why it wants to criticize you so much” or “imagine the voice talking to you in a cartoon-like high pitch that makes it sound ridiculous” might be helpful for my friend, while making me just go “huh?”.
Now, this would imply that you could figure out which therapy works best for who, and then match clients to the therapies that work best for them. So far, studies that have attempted to do this have had disappointing results. But then, it’s unclear what good predictors would be.
If you asked me to give you an objectively measurable trait that could be used to predict whether someone benefits from IFS, I’d struggle. I sometimes tell people that “I tend to get the best results with people who’ve already tried something like Focusing or IFS and found it promising”. But that’s not really a predictor, it’s just saying that my method works best for the kinds of people who have already found it to work for them.[4]
Being intuitive and in touch with your emotions helps quite a bit, but I’d expect such people to do well in any form of therapy. You might also expect something like “finds the notion of the mind being divided into parts intuitive” to be a good predictor… but I initially kept bouncing off IFS because all descriptions of it sounded hopelessly woo and unscientific, while some of my clients totally buy the model intellectually but still struggle to connect with their parts.
So it seems to me that different people’s problems are configured in different ways, some therapies are better than others in solving a particular problem or configuration but none is universally best for everything, and it’s hard to predict in advance what would work for any given person.
Some of the therapies and approaches might also change one’s configuration so as to unlock new approaches. For example, IFS and many of the other experiential therapies are often not very effective for people who have difficulty feeling their emotions. Practicing Gendlin’s Focusing and doing body scan practices are approaches that can get people more in contact with their emotions. This can then make it easier to get benefits from other therapies.
I noted before that many frameworks have their own ideas of what works and what needs to happen for things to get better. If you accept any one of these claims as truth, it can be strongly motivating - “I just need to heal my trauma to fix my problems” or “I just need to surround myself with enthusiastic people to fix my problems” - as long as you seem to be on track to doing that. But if it starts looking like you’re not making progress toward it for whatever reason - maybe you can’t find the original trauma, maybe you’re failing to find sufficiently enthusiastic people - then it is easy to start feeling hopeless. Alternatively, you might retain the excitement for the method, and keep grinding on something that isn’t actually a good approach for your problem.
But if there are many different interventions that could potentially work, then that’s a source of hope. If you have been grinding on one school’s approach for a while and making little progress, it’s still possible that another one will work! And while it might not solve your problems entirely, it will still make your life easier and improve your odds of tackling the remaining parts of it - or maybe just conclude that the problem is sufficiently under control that you can let it be and move on.
With all of that out of the way, I can now finally discuss possible reasons for practitioners to think that their framework is The One True One. Now many of these might affect me as well - and have historically affected me, for there was a time when I thought everyone just needed to learn IFS and then all of our psychological problems would be fixed. Turns out that I still think it’s great and extremely beneficial for some people, but alas, it didn’t fix even all of my psychological problems.
Typical mind fallacy. It is a common experience for people to hear different kinds of advice, note that it doesn’t work for them, and then assume that the advice was bad rather than the advice being something that just didn’t work for them. Scott Alexander writes:
I only really discovered this in my last job as a school teacher. There’s a lot of data on teaching methods that students enjoy and learn from. I had some of these methods...inflicted...on me during my school days, and I had no intention of abusing my own students in the same way. And when I tried the sorts of really creative stuff I would have loved as a student...it fell completely flat. What ended up working? Something pretty close to the teaching methods I’d hated as a kid. Oh. Well. Now I know why people use them so much. And here I’d gone through life thinking my teachers were just inexplicably bad at what they did, never figuring out that I was just the odd outlier who couldn’t be reached by this sort of stuff.
If it is the case that different therapies work for different people, then someone may have gone through a number of therapies before finding one that clicked for them. Maybe CBT didn’t do anything for them but IFS did, or vice versa. Then they find a community of people who have all had a similar experience, end up mostly talking to each other, and conclude that “obviously IFS is the only thing that works while all the people promoting CBT are just inexplicably bad at doing therapy”.
The ontological “when all you have is a hammer” issue. These frameworks do more than just offer possible solutions. They also have their own ontologies about what the problem even is. Internal Family Systems sees everything in terms of parts of the mind; some meditative traditions see everything in terms of tanha; the biological frameworks might frame things in terms like inflammation, cortisol, blood sugar, and sleep debt. Since a lot of phenomena really are explained and well-modeled through these kinds of concepts, it’s possible to start seeing everything through a particular framework’s vocabulary, which makes it harder to conceive of any alternatives.
This is especially so as getting better at applying each framework tends to involve learning to see the world through its lens. Learning IFS has you seeing everything in the mind as parts, learning CBT has you recognizing cognitive distortions in all of your issues, vipassana might have you seeing tanha everywhere. Each of these operates on a somewhat different level of perception, so that focusing on one level may blur out the others.
Selection effects are a thing. It’s easy for various selection effects happen - for one, the practitioner has to market themselves somehow, and any kind of marketing will be appealing to some people and unappealing to others. People will also self-select - someone who thinks their problems are caused by trauma is likely to be looking for a trauma specialist. This might make it more likely for practitioners to get the kinds of clients their framework is good for.
Also, someone who thinks their problems are caused by trauma is also likely to believe in frameworks that emphasize the significance of trauma in particular. That means that the client is less likely to challenge the practitioner’s beliefs and more likely to actively affirm them. Logically, “your clients agree with you about your framework being valid” shouldn’t cause a practitioner to change their beliefs - the practitioner is supposed to be the expert, and they should be looking at results not pre-existing client beliefs. But practitioners are humans too, and humans tend to automatically believe more in anything that people in their social environment affirm.
Wishful thinking. “I know the one method that is key to solving everyone’s problems” can be a belief you are very motivated to hold - either for an egoistic or altruistic reason! The thought of being able to personally fix everyone’s problems can feel very satisfying to imagine. And if one is strongly motivated to help other people, they may want to believe that there exists a way to fix everyone’s problems and that nobody is beyond saving.
Many problems are multicausal. Maybe you have ADHD, trauma, and you don’t get enough exercise. Each of these is likely to hurt your emotion regulation, and the effect of the three may be closer to multiplicative than additive. So if someone believes that “you should just lift, bro”, even if the lack of lifting wasn’t the only core reason for your mood problems, following the advice may still produce a sufficient improvement to make one think that it was the core problem.
Multicausality may look monocausal in retrospect. I mentioned earlier that many practitioners may believe in a method because it turned out to be transformative for them. This may be true even if they actually needed a lot of other methods to get there.
Many people working through their issues will experiment with many different methods, each method allowing them to dissolve a part of the problem. Then they find some particular method that lets them solve the rest of it… and then attribute all of their success to that method, thinking that if they had just used that method all along, they wouldn’t have needed to waste all this time.
But all of those previous methods weren’t actually wasting time. They were the right methods for the stage the person was at previously, and the last method they found might even have been entirely ineffective at that point.[5]
Persistence often pays off... Some issues that are caused by e.g. trauma don’t seem obviously connected to anything traumatic at first. And some problems that seem obviously psychological may turn out to be physical with sufficient investigation. Some very deeply buried trauma or obscure medical condition may require a lot of looking into by expert practitioners before the underlying trauma or origin becomes apparent, and then one might get significant results.
This means that if someone has a strong frame of “everything is about trauma” or “everything is physiological”, they will keep pursuing that hypothesis at a point where someone holding broader views would already have switched to another hypothesis - which will be the correct thing to do in cases where someone’s problems are mostly caused by that, and wrong in cases where they aren’t.
The trauma specialist who keeps digging for a year before the buried trauma surfaces may be behaviorally identical to the trauma specialist who keeps digging for a year on someone whose problem was a thyroid condition. Whether that digging was correct or not depends on the base rate of trauma-caused depression versus thyroid-caused depression - which is exactly the thing that’s in dispute between the different practitioners.
…even if the results aren’t impressive. With enough digging, one might always be able to find some trauma that could be related to the issue, or some medical issue that could conceivably be making things worse. This may be true even when it’s not actually a particularly crucial part of the issue. So a person who has repeatedly had the experience of, say, “enough digging will surface an underlying trauma” may find their “everything is caused by trauma” model confirmed once they do manage to find one.
If this then fails to significantly shift the issue, when fixing many other traumas has significantly shifted people’s issues, the failure may be attributed to something like “this trauma must have other aspects we haven’t managed to uncover yet”. (Which may still sometimes be true and key to resolving the issue!)
Therapeutic progress is intrinsically noisy. Some clients will inevitably drop out or fail to make progress for reasons entirely unrelated to the validity of the framework. Maybe the client’s and practitioner’s personalities just didn’t happen to work well together, maybe the circumstances in the client’s life got a lot more stressful, maybe they just decided to focus on something else. It’s often the correct move to expect this to happen and to not trust the framework any less for it.
But this means that it becomes hard to distinguish between “all the clients who stuck with me long enough saw significant improvements because the method happened to work for them and made them persist” and “all the clients who stuck with me long enough saw significant improvements, but couldn’t stick to it because of factors outside my control”. This doesn’t necessarily even take the form of blaming the client - the practitioner can even put it down to something like “I wasn’t good enough at motivating them”.
Combined with the multicausality, the practitioner might even have witnessed that the clients who dropped out saw genuine progress. The “just lift, bro” guy might have seen someone’s emotional regulation make real progress because of the lifting - but failed to note e.g. the client’s trauma or ADHD making it too hard to persist with the weightlifting in the long term. So it will look to them like “if the client had just continued, they’d have felt much better”... which may be true, but is failing to notice the thing that prevented the client from “just continuing”.
Frameworks often have different values. Suppose that you are in a high-achieving career, which you are pursuing due to an internalized belief that you absolutely need to be high status in order to be loved. This leads to some distorted thinking, so you work with a CBT therapist to fix it. This leaves your underlying emotional compulsion to pursue status at the expense of everything else unchanged, but frees you to pursue it more effectively. It also makes it so that you are less likely to burn out, which would allow you to work on your deeper issue.
Is this a success?
Even if one was trying to rigorously measure the success of various frameworks with randomized controlled trials - and was able to control for all the confounders - the possible weaknesses of this approach will be invisible. No RCT measures a counterfactual like “would the person have been ultimately happier and more fulfilled if they had been allowed to burn out and then pursued an entirely different methodology”. Instead, it might just show that your mental health has improved and that you are achieving all of your goals better.
But other practitioners - maybe ones who had themselves burned out, been forced to do deeper work, and then found themselves grateful for that - might see this result as worse than doing nothing. (Note that I’m not claiming that pursuing a high-achieving career is always done out of unhealthy motivations. Just that it sometimes is.)
The most extreme disagreement might come from the Buddhist-leaning teachers. Some of them might hold that any life motivated by the belief that one needs to chase positive feelings and avoid negative ones is a prison and a delusion.
Meanwhile, some of their approaches might lead people to start preferring an existence of just meditating in a monastery for the rest of their lives… which the more engagement-focused practitioners might see as a failure to promote a genuinely flourishing life.
And as I noted before, value differences also covers things like differing tolerance for risk. The IFS approach of the “always proceed slowly, only work with material that you can witness from the outside” minimizes in-session discomfort and the risk of the client getting overwhelmed. A psychedelic intervention that throws the client right back into their original trauma to release it can be faster and deeper, while also being riskier and much more painful.
Okay, so it’s nice to know what makes everyone think they have The One Solution. But you don’t just want to theoretically understand it, you have some issue that needs fixing, and you want to find a practitioner who’ll actually help you. What do you do?
Alas, I don’t have any clear-cut solution. But here are some thoughts:
Most obviously, be willing to try different things.Also, be willing to try different practitioners! Even if the framework does make a difference, common factors and client-practitioner fit also matter enormously. I personally like IFS but I’ve also heard horror stories about bad IFS practitioners, and I’m sure there are lots of people who’d benefit from IFS who I just wouldn’t happen to click well with.Do a common-sense sweep to your issues. If you’re never getting any exercise and only eating frozen pizza, you don’t need to see an expert to know there are potential gains to be made. (That said, if awareness of never getting any exercise and only eating frozen pizza fills you with such shame that you can’t make any progress toward fixing this, do see a therapist about that and don’t feel like you have to fix the exercise and nutrition first.)If possible, start with cheap tests. Blood tests to exclude an obvious medical issue are lower cost than a year of trauma therapy.Ask the practitioner on their track record with similar problems, and when they would suggest you stop working with them. If they say this works for everything, be suspicious. Though a more caveated response like “this doesn’t work for everything, but I think letting go of tanha is the most valuable thing so I’m only focusing on that” shows self-awareness.Ask them about the last time when they did recommend someone stop working with them. If they cannot think of a single time, or have to pause for a long time to think of somebody, that suggests they do not have real off-ramps.In that regard, it’s worth being explicit about what your goals are and making sure yours agree with the practitioner’s.Do sometimes delegate things to the practitioner - if they say “I know you’re not feeling any progress right now but I honestly think we’re close” and they seem honest, probably give that a chance.There are different bottlenecks - if one approach fails to work for a while, it may work better later (e.g. some people find that CBT starts to work after trauma work; approaches focusing on bodily sensations may unlock other approaches bottlenecked on your ability to feel your body).If you have the time and energy for it, some things can be tried in parallel and may actually be synergistic. Combining antidepressants with psychotherapy is the classic one. Or if you have a lifelong aversion to exercise, you can see a doctor to see if there’s a contributing medical issue while also seeing a therapist about any emotional factors related to it. The downside of this is that if you try a combo and you feel better, you won’t necessarily know whether it was one or the other or both together that made the difference.Finally, don’t forget that “I’m going to go through every possible therapy and spiritual practice until I find one that works to fix my problems” can also be a form of avoidance.
Gretta Duleba has an article about Relationship Known Issues. In software, a Known Issue is a problem that the developers know about but have no plans to fix - because it would be hard, because the issue doesn’t matter much, or because they just have more important things to do.
Relationships can also have issues. Maybe one partner snores so much the other can’t sleep, but the two would like to sleep in the same room anyway, and this is a source of ongoing pain. It then makes sense to pursue solutions, but if nothing works out, it might be best to just treat it as a Known Issue and live with it rather than start resenting the partner or the relationship for it.
One’s life can also have Known Issues. If nothing else, the inevitability of everyone’s death is a Known Issue. It’s good to look for solutions if it seems like solutions are available, but it can also be a relief to just give up on trying to find one.
Alas, it seems impossible to ever know for certain when you should give up on trying and when you should persist. “I will try everything you fix my issue” can be a defense, but so can “there’s no point in even trying anything”.
I’m treating that impossibility of knowing as a Known Issue with life.
^^Mulder, R., Murray, G., & Rucklidge, J. (2017). Common versus specific factors in psychotherapy: opening the black box. Lancet Psychiatry, 4(12), 953-962.
^I can’t totally reject a pure common factors explanation on the basis of these examples alone, though. “This person had a breakthrough with me after trying several other therapists and coaches” could be driven by “my method worked particularly well for the person” or it could be driven by “personality-wise, I happened to be a better fit for them than anyone else they tried”. And e.g. the people who benefit the most from working with me also tend to be the ones I have the best rapport with, so I do certainly agree that the common factors are very important.
I should also note that drastic improvement within a single session is not unique to IFS, but also happens in CBT as well as a range of other therapy modalities. My interpretation is that various modalities can happen to hit exactly the right spot for what the client needs, but a common factors proponent could also argue that this is a sign the modality doesn’t matter and it’s only about getting a good match with the therapist.
To which I can only say that I see the argument, but having tried multiple modalities, that just doesn’t feel plausible to me.
^The first rule of tautology club is the first rule of tautology club.
^