Fascinated by the research studies that Rubin Battino provides as a background to his book Expectation: The Very Brief Therapy Book (2006), I invited him to provide us with a commentary on his book and his viewpoint. Independently Mike Heap sent the book out for review to Dr Robert Hill; a review which is also published in this issue.
The trajectory that led to Rubin Battino's engagement with psychotherapy is an unorthodox one, and one that provides him with an 'eyes-wide-open' perspective combined with the rigour of a natural science discipline. His initial training and career was in chemistry and only on retirement did he train as a psychotherapist. This has clearly captivated him, leading to a series of books; though he still provides chemistry demonstrations to lucky US high school students.
His is a prescient intelligence. As he says (2006: 23) when he outlines the content of the introductory background chapter, 'I had not yet read the books by Wampold, Duncan, Miller and colleagues', which he went on to utilize to set the stage for his thesis and therapeutic approach. I will not comment on his psychotherapy, but rather touch on some of the background issues that intrigued me.
Battino fi rst draws inspiration from Wampold (2001) The Great Psychotherapy Debate: Models, Methods and Findings, whose wry observations on the psychotherapy profession revive the Dodo effect (Rosenzweig, 1935). This was a quip derived from Alice's Adventures in Wonderland where of the Dodo at the races we read, ' "At last," the Dodo said, "Everybody has won, and all must have prizes" '. An observation that proves to be apposite in the context of 'expectation'.
He begins with the distinction Wampold (2001) makes between the medical and contextual models of psychotherapy; Wampold preferring the latter wherein emphasis is placed on the meaning attributed by the patient to the therapeutic procedures, as distinct from the specifi c effects of the procedures themselves. This contrasts with the medical model where remedies are contingent on specifi c therapeutic constituents. The contextual model rather emphasizes the commonalities in psychotherapies as distinct from their relative effi cacy. In one study estimates towards outcome were gauged, such that extratherapeutic change contributed 40%, followed by commonalities such as empathy, acceptance, warmth, etc. which contributed 30%, while expectancy/placebo and specifi c procedures each contributed only 15% (Lambert, 1992). This distinction, and evidence in support of it, becomes a persistent motif in Battino's thesis in the background chapters, including plentiful quotes from Duncan, Miller and Sparks (2004) The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-directed, Outcome-informed Therapy.
Battino then turns to Hubble, Duncan and Miller (1999) The Heart and Soul of Change: What Works in Therapy, in essence drawing on the rubric 'the client is the engine of change'. And, crucially for Battino's expectation hypothesis, evidence that