Beyond the specific factors versus common factors debate: Lacan’s four discourses informing Wampold and Imel’s contextual model of psychotherapy efficacy

Abstract

This article is a critical reflection on the limitations of current metatheoretical models of psychotherapy efficacy that have emerged from the historic specific factors versus common factors debate. It argues that while Wampold and Imel’s (2015) contextual model of psychotherapy efficacy does capture the importance of the real relationship occurring across diverse modalities of psychotherapy, it inadequately accounts for important differences in psychotherapy relationships stemming from the different intersubjective contexts produced by different modalities of psychotherapy. This leaves Wampold and Imel’s contextual model open to criticism from Butler and Strupp’s (1986) earlier warning against producing a new “uniformity myth” of the therapeutic relationship. Lacan’s four discourses are introduced and discussed as a theoretical framework helpful for distinguishing different intersubjective contexts occurring in different forms of psychotherapy, with the implication that these contexts may produce distinct, qualitatively different kinds of psychotherapy effects.