Fonagy, P; Campbell, C; (2017) Mentalizing, attachment and epistemic trust: how psychotherapy can promote resilience. Psychiatria Hungarica , 32 (3) pp. 283-287.

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Abstract

Over the past decades, meta-analyses have failed to find almost any clinically meaningful differences in efficacy between the various evidence-based psychotherapies. This has led to the formulation of the so-called “Dodo bird verdict”, based on the Alice in Wonderland story, which argues that “all [psychotherapies] have won and all must have prizes”. Consequently, major figures in the field have questioned the notion that theory-specific techniques or interventions, such as addressing dysfunctional cognitions in cognitive-behavioral therapy, or the relationship between past and present in psychodynamic therapy, are mainly responsible for therapeutic outcome. They argue that, instead, factors that are common to effective treatments – providing the patient with hope and with a comprehensive theory that explains the patient’s complaints – would typically explain a greater proportion of the therapeutic outcome. This would be particularly the case if the therapist is able to establish a warm and empathic therapeutic relationship with the patient. Hence, the “Dodo bird” still looms unresolved over the field of psychotherapy (Budd & Hughes, 2009; Mansell, 2011). In this paper, I will attempt to set out a new, evolutionarily informed approach to the “Dodo bird” controversy, which we speculate may have implications for understanding psychopathology more generally.

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