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Commentary on “beyond the efficacy ceiling”
BEHAVIORTHERAPY28, 613-614, 1997
Commentary on "Beyond the Efficacy Ceiling" Responses to an Irrelevant Subtitle JOSEPH WOLPE
Pepperdine University Foa and Kozak (1997) appear to have been led by the irrelevant subtitle of this special issue into discussing a number of matters unworthy of their efforts, including the mundane observation that behavior therapy is not without failures, and the unsupported contention that behavior therapy is in search of a theory. However, the authors draw needed attention to the fact that the cognitive contribution to behavior therapy is not derived from experimentation and that experimental findings are not as much drawn upon as they should be in behavior therapy.
Edna Foa and Michael Kozak (1997) are productive and prestigious behavior therapists, but the irrelevant subtitle of the special issue has evidently drawn them into articulating a series of propositions that, left to themselves, they would never have conceived. They seem to have assumed that this special issue's title, "Thirty Years of Behavior Therapy: Promises Kept, Promises Unfulfilled" represented a concrete state of affairs-a set of circumstances that had been examined and confirmed. Promises have never been an issue in behavior therapy, but their mention may have encouraged Foa and Kozak's confusing title for their own paper, "Beyond the Efficacy Ceiling? Cognitive Behavior Therapy in Search of a Theory" It turns out that the phrase "efficacy ceiling" is nothing but the recognition that, objectively, the efficacy of behavior therapy is limited- in other words, it is not infallible. Everybody working with behavior problems-even using such an efficient mode as behavior therapy-knows that success cannot be taken for granted. Behavior therapists have always recognized the inevitability of failures (Foa, in fact, documented this in a 1983 co-edited book with Emmelkamp titled Failures in Behavior Therapy): So the presumed revelation of the imperfect efficacy of behavior therapy is very old hat. It also turns out that the second part of Foa and Kozak's (1997) title, "Cognitive Behavior Therapy in Search of a Theory" has practically no role in the content of their paper. One section of the paper is headed "The Role of Correspondence concerning this article should be addressed to Joseph Wolpe, Pepperdine University, Psychology Department, 400 Corporate Pointe, Culver City, CA 90230. 613 0005-7894/97/0613-061451.00/0 Copyright 1997 by Associationfor Advancementof BehaviorTherapy All rights of reproduction in any form reserved.
614
WOLPE
Theory in Cognitive Behavior Therapy?' This section illustrates how behavior therapy originally emerged from work in experimental psychology, as typified by systematic desensitization, implosive therapy, and Lang's use of conditioning principles in the treatment of life-threatening vomiting in an infant. There is also mention of experimental psychology having been heavily influenced by information-processing concepts related to the technology of computer science. In none of these contexts is there any reference to behavior therapy in search of a theory. The authors do, in the context of a wide-ranging discussion, question whether progress in behavior therapy is "really slowing?' Without defining this "slowing" or examining evidence for it, Foa and Kozak devote a great deal of effort to finding explanations for it. In so doing, however, they draw much-needed attention to the realization that the cognitive contribution to behavior therapy is, unlike the conditioned side of it, derived not from experimental observations but from introspections on the part of patients. Foa and Kozak (1997) also note the pervasive lack of use of the findings of experimental psychology in clinical treatments. They suggest that one of the reasons for this may be that "experimental psychology is still too theoretically inchoate to offer much guidance about thorny clinical p r o b l e m s . . . [and] therapy researchers have not made use of existing knowledge of basic psychopathology research" (p. 606). The essence of the matter, however, is that experimental facts do not automatically line themselves up for clinical use. It is necessary for workers in the field to make use of existing knowledge to formulate experiments that may be expected to cast light on the problems of psychopathology and clinical syndromes. It was through specially constructed experiments that methods such as systematic desensitization entered the armamentarium of behavior therapy.
References Foa, E. B., & Emmelkamp, P. M. G. (1983). Failures in behavior therapy. New York: Wiley. Foa, E. B., & Kozak, M. J. (1997). Beyond the efficacy ceiling? Cognitive behavior therapy in search of theory. Behavior Therapy, 28, 601-611. RECEIVED: June 17, 1997 ACCEPTED: July 10, 1997
Commentary on "Beyond the Efficacy Ceiling" Responses to an Irrelevant Subtitle JOSEPH WOLPE
Pepperdine University Foa and Kozak (1997) appear to have been led by the irrelevant subtitle of this special issue into discussing a number of matters unworthy of their efforts, including the mundane observation that behavior therapy is not without failures, and the unsupported contention that behavior therapy is in search of a theory. However, the authors draw needed attention to the fact that the cognitive contribution to behavior therapy is not derived from experimentation and that experimental findings are not as much drawn upon as they should be in behavior therapy.
Edna Foa and Michael Kozak (1997) are productive and prestigious behavior therapists, but the irrelevant subtitle of the special issue has evidently drawn them into articulating a series of propositions that, left to themselves, they would never have conceived. They seem to have assumed that this special issue's title, "Thirty Years of Behavior Therapy: Promises Kept, Promises Unfulfilled" represented a concrete state of affairs-a set of circumstances that had been examined and confirmed. Promises have never been an issue in behavior therapy, but their mention may have encouraged Foa and Kozak's confusing title for their own paper, "Beyond the Efficacy Ceiling? Cognitive Behavior Therapy in Search of a Theory" It turns out that the phrase "efficacy ceiling" is nothing but the recognition that, objectively, the efficacy of behavior therapy is limited- in other words, it is not infallible. Everybody working with behavior problems-even using such an efficient mode as behavior therapy-knows that success cannot be taken for granted. Behavior therapists have always recognized the inevitability of failures (Foa, in fact, documented this in a 1983 co-edited book with Emmelkamp titled Failures in Behavior Therapy): So the presumed revelation of the imperfect efficacy of behavior therapy is very old hat. It also turns out that the second part of Foa and Kozak's (1997) title, "Cognitive Behavior Therapy in Search of a Theory" has practically no role in the content of their paper. One section of the paper is headed "The Role of Correspondence concerning this article should be addressed to Joseph Wolpe, Pepperdine University, Psychology Department, 400 Corporate Pointe, Culver City, CA 90230. 613 0005-7894/97/0613-061451.00/0 Copyright 1997 by Associationfor Advancementof BehaviorTherapy All rights of reproduction in any form reserved.
614
WOLPE
Theory in Cognitive Behavior Therapy?' This section illustrates how behavior therapy originally emerged from work in experimental psychology, as typified by systematic desensitization, implosive therapy, and Lang's use of conditioning principles in the treatment of life-threatening vomiting in an infant. There is also mention of experimental psychology having been heavily influenced by information-processing concepts related to the technology of computer science. In none of these contexts is there any reference to behavior therapy in search of a theory. The authors do, in the context of a wide-ranging discussion, question whether progress in behavior therapy is "really slowing?' Without defining this "slowing" or examining evidence for it, Foa and Kozak devote a great deal of effort to finding explanations for it. In so doing, however, they draw much-needed attention to the realization that the cognitive contribution to behavior therapy is, unlike the conditioned side of it, derived not from experimental observations but from introspections on the part of patients. Foa and Kozak (1997) also note the pervasive lack of use of the findings of experimental psychology in clinical treatments. They suggest that one of the reasons for this may be that "experimental psychology is still too theoretically inchoate to offer much guidance about thorny clinical p r o b l e m s . . . [and] therapy researchers have not made use of existing knowledge of basic psychopathology research" (p. 606). The essence of the matter, however, is that experimental facts do not automatically line themselves up for clinical use. It is necessary for workers in the field to make use of existing knowledge to formulate experiments that may be expected to cast light on the problems of psychopathology and clinical syndromes. It was through specially constructed experiments that methods such as systematic desensitization entered the armamentarium of behavior therapy.
References Foa, E. B., & Emmelkamp, P. M. G. (1983). Failures in behavior therapy. New York: Wiley. Foa, E. B., & Kozak, M. J. (1997). Beyond the efficacy ceiling? Cognitive behavior therapy in search of theory. Behavior Therapy, 28, 601-611. RECEIVED: June 17, 1997 ACCEPTED: July 10, 1997