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Introduction

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The Dodo Bird Verdict: A Brief History

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"Everybody has won and all must have prizes."

The "Dodo Bird Verdict" is one of the most hotly debated topics in all of psychology. According to the Dodo Bird Verdict, all psychotherapies, regardless of their specific components, produce equivalent outcomes. The Dodo Bird debate took flight in 1975 when Singer and Luborsky reported the results of one of the first comparative study demonstrating few significant differences in the outcomes among different psychotherapies [1]. This study has spurred a plethora of new studies in both opposition and support of the Dodo Bird Verdict [2].


The “Dodo Bird Verdict” terminology was first coined by Saul Rosenzweig (1936) to illustrate the notion that all therapies are equally effective [3][1][4]. Rosenzweig borrowed the phrase from Lewis Carroll's Alice's Adventures in Wonderland (1865), where, at a certain point, a number of characters become wet and in order to dry themselves, the Dodo Bird decided to issue a competition. Everyone was to run around the lake until they were dry. Nobody cared to measure how far each person had run, nor how long. When they asked the Dodo who had won, he thought long and hard and then said "Everybody has won and all must have prizes." Thus, in the case of psychotherapies, the Dodo Bird Verdict means that all therapies are winners, and thus, all must have prizes.


The Dodo Bird debate, in brief, is focused on whether or not the specific components of different treatments lead some treatments to outperform other treatments for specific disorders. Supporters of the Dodo Bird Verdict contend that all psychotherapies are equivalent because of "common factors" that are shared in all treatments (i.e., having a relationship with a therapist who is warm, respectful, and has high expectations for client success[5][6]. In contrast, critics of the Dodo Bird Verdict would argue that the specific techniques used in different therapies are important, and all therapies do not produce equivalent outcomes for specific disorders.

Controversy

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Support for the Dodo Bird Verdict

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The common factor theory states that all therapy in psychology is equally effective because of the common factors shared among all therapies in psychology. So the specific techniques or strategies that are unique to the individual studies are ineffective in the treatment outcome of the patient. Instead, the only causal agents in treatment are the common factors [7][8][9][10] So the specific techniques or strategies that are unique to the individual treatments are ineffective in the treatment outcome of the patient[11]


One common factor is the client-therapist interaction. A 1992 study by Lambert showed that nearly 40 percent of the improvement in psychotherapy is from these client-therapist variables[12]. Other researchers have further analyzed the importance of client-therapist variables in treatment. Researchers found that improvement in the patient was up to the patients themselves because the data showed that if patients were able to change their attitude they would improve[1][3][13]. Wamphold et al 2002, found that 7% of the variability in treatment outcome was due to the therapeutic alliance whereas 1% of the variability was due to a specific treatment [14][15] [13] [16] The therapists attitude is also a very important causal agent in positive patient change. Najavits and Strupp 1994, demonstrated that a positive, warm, caring, and genuine therapist generated statistically significant differences in patient outcome [17] This shows that basic human qualities, not specific treatment qualities, are the determining factor for client improvement. Wamphold et al 2002, also found that nearly 70% of the variability in treatment outcome was due to the therapist’s attitude toward the efficacy of the treatment[14]


Opposition to the Dodo Bird Verdict

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In refutation of the Dodo Bird Verdict, there is strong evidence that some treatments are in fact better for particular disorders when compared to other treatments [18][19]. Here, in contrast to the common factor theory, qualitative components of the therapy have statistically significant results[20][21]Cite error: The <ref> tag has too many names (see the help page).. Luborsky, Singer, and Luborsky’s 1975 review on comparative outcomes of psychotherapies is one of the most well-known studies executed in the support of the Dodo Bird Verdict, however, although 30 years ago a general equivalency of the effect sizes of psychotherapies may have seemed accurate, that is not at all the case today, [22][23]. With the improvement of research and the growth of psychology as a field in general, the treatments used by clinicians have evolved as well. We are no longer in the practice of bloodletting and lobotomies. Today especially, with the evolution of empirically supported treatments, there is a greater emphasis on treatment integrity and specificity than what there had been early on in psychotherapy practices[23].


One of the more common critiques against evidence in support of the Dodo Bird Verdict has to do with the legitimacy of the meta-analyses used in the study. These meta-analysis comparative tests unfortunately are not invulnerable to the subjective agenda of many psychologists[24]. Arguments have proposed that the specific meta-analysis the Dodo Bird Verdict is based on (Luborsky, Singer, Luborsky 1975) could possibly produce misleading results because of the type of studies combine in the comparison, [22][25][26]. A startling 43% of studies that support the Dodo Bird Verdict, yielding a report that concludes no outcome difference, are found not to have the sensitivity to detect differences in therapies even if they did exist [27] Some meta-analyses constructed are not sensitive to the subtle distinctions between treatment effects, especially among comparative studies of highly similar treatments [22][27][28]

Issues in Testing

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The heart of the controversy over this theory lies precisely in the mechanism used to evaluate it. The controversy of the Dodo Bird Verdict essentially originates from the fundamental problems of Meta-analyses[29] The obvious lack of clear psychotherapeutic evidence for the support of either side in the debate comes from the fundamental problems of Meta-analyses when used for comparing treatments “head to head”[29]. These massive comparative studies have been used to compare the effect sizes of different treatments. Unfortunately, there ability in finding a reliable and valid effect size is heavily scrutinized by some[2]. This is because many researchers are said to have an agenda when conducting a meta analysis. Thus, they hand select which experiments they want to use in their study to product the end result that they want, not what would be best represented scientifically[24] This incites bias and should be discarded. Unfortunately, it is difficult to filter through valid and invalid science.


This seems to be the difficulty with a clear answer to the Dodo Bird Verdict. For example, Wampold 2009, found Siev et al 2007 study whose research for significancy of CBT versus RT was resting on one experiment with a uncharacteristically large effect size (1.02) by Clark et al 1994[30]. Wampold 2009 found this effect size to be invalid because of the biases of the study. When this flawed experiment was removed, the effect size was not statistically significant for the use of CBT over RT in panic disorder therapy. On contrary to The Verdict, Chambless 2002, found that “errors in data analysis, exclusion of research on many types of cients, faulty generalization to comparisons between therapies that have never been made, and erroneous sorts of treatments for all sorts of problems can be assumed to represent the difference between any two types of treatment for a given problem.”[31] Here, Chambless 2002 forcefully critiques many Dodo Bird supporting studies. It is clear that meta-analyses need to be conducted carefully for them to be taken seriously. In support of the anti-Dodo Bird side, Hunsley 2007 says that when “measurement quality is controlled for and when treatments are appropriately categorized, there is consistent evidence in both treatment outcome and comparative treatment research that cognitive and behavioral treatments are superior to other treatments for a wide range of conditions, in both adult and child samples.”[29]

Conclusion

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Importance of the Verdict

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The outcome of the Dodo Bird Debate has extremely important implications for the future of clinical psychology. Indeed, policymakers have to decide on the usefulness of investing in the diversity of psychotherapies that exist. If the Dodo Bird is thought to be true, then many clinicians would feel free to use any therapy they seem fit. However, if the Dodo Bird is put to rest, then clinicians would likely have to use empirically supported therapies when treating their clients.


Although recent research appears to support both sides of the debate, many clinical scientists have begun to declare the Dodo bird verdict to be statistically and clinically inappropriate[22] For example, the use of CBT-based therapies for treating panic disorder (PD) cases are clearly a winner [32][33] They found that CBT does improve patient pathology in five panic related symptom domains. There are many studies that echo similar results brought about by Sieve 2010[34] [35]. Despite this strong evidence in refutation of the Dodo BIrd Verdict, debate rages on.


Perhaps the greatest illustration of the current state of the Dodo Bird Verdict is seen in meta-analyses of Wampold and Barlow and response to it. In these meta-analyses, researchers on both sides point out weaknesses and inconsistencies. Although both sides are both trying to improve psychology in their perspective ways, the disagreement and lack of consistent evidence for the Dodo Bird Verdict may in fact be weakening people’s views of the field. For example, these overall inconsistencies in the scientific plausibility may lead governmental officials to cut funding for psychological treatments and other public health measures[36][37][38] Another possible consequence of the debate could be the increase of public doubt of the field. Generally speaking in present day, the public does not regard psychology as a hard and applied science[39][40] [41] Although this is what these researchers are trying to obtain, they may be doing more harm than good, because as of now, clinical psychology is failing as an applied science.[42]

References

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