MADISON - The drive by HMOs to "medicalize" psychotherapy - insisting that practitioners look for a medical disorder such as clinical depression and then dispense a prescribed treatment - will ultimately suffocate psychotherapy through ignorance of how it works.

That's the contention of Bruce Wampold, professor of counseling psychology at the University of Wisconsin-Madison and author of a new, controversial book, "The Great Psychotherapy Debate."

Based on a comprehensive quantitative review of studies on psychotherapy's effectiveness, he rejects the a-pill-for-a-pain approach of HMOs and clinical scientists who use a medical model for psychotherapy.

"The evidence is clear," Wampold says. "There is a dramatically greater variance in outcomes due to the therapist, compared to the chosen treatment. A person with a need for psychotherapy should seek the most competent therapist possible without regard to various therapies."

In fact, Wampold's analysis shows that specific treatments or techniques account for less than 1 percent of the variance in improvement in psychotherapy patients. It's the therapist that counts, not the therapy.

Wampold contends that the research does not support the current trend to identify certain treatments for particular disorders regardless of the characteristics of the patients. Instead, he proposes a contextual model that takes into account patient attitudes, values, culture and world view.

Medicalizing psychotherapy has ominous overtones, he says: "Medicine, which includes the pharmaceutical companies, is a bold gorilla that will crush the warm, fuzzy psychotherapy teddy bear. For example, you are infinitely more likely to see TV ads for Prozac or Zoloft to treat depression than for psychotherapy."

Wampold believes that medicine and psychotherapy can work together without forcing psychotherapy into a medical reimbursement mentality. Moreover, universities should focus their training on the therapeutic skills so important to improving clients' lives - empathetic listening and responding, building client relationships and self-reflection.

---University of Wisconsin, Madison

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