Is All Therapy Created Equal? What the Dodo Bird Effect Tells Us
What is the Dodo Bird Effect? Learn how it challenges therapy comparisons and explores what drives mental health outcomes.
In Alice in Wonderland, Lewis Carroll introduces a peculiar character, the Dodo Bird, who presides over a chaotic race where no one finishes first. Declaring, “Everybody has won, and all must have prizes,” the Dodo Bird symbolises fairness without clear criteria. This whimsical moment inspired the term Dodo Bird Effect in psychology, suggesting that all forms of therapy lead to similar effects. Introduced by Saul Rosenzweig, the theory challenges the focus on specific treatment methods in psychotherapy, proposing instead that shared factors like empathy and trust are what truly drive patient improvement in mental health care.
Is the Dodo Bird Effect Valid or Just a Persistent Myth?
The Dodo Bird Effect suggests that all forms of psychotherapy lead to similar effects, not because of the specific techniques used, but due to shared factors like empathy, trust, and the therapeutic relationship. This theory gained traction through Rosenzweig’s 1936 paper and was supported by later meta-analyses.
However, more recent analyses challenge its universality. Some argue that certain treatments, like CBT for anxiety or exposure therapy for PTSD, consistently outperform others in specific contexts. While the effect is not a myth, it may not be as universally applicable as once thought.
How Does the Anti-Dodo Bird Verdict Challenge the Theory?
The Anti-Dodo Bird Verdict pushes back against the idea that all forms of psychotherapy lead to similar effects. Critics argue that the original studies supporting the Dodo Bird Effect failed to control for variations in therapist experience, therapy fidelity, and treatment fit.
Studies have shown that some treatments outperform others for specific mental health conditions. For example, Cognitive Behavioural Therapy (CBT) developed by Beck (1960) consistently produces better outcomes for anxiety, obsessive-compulsive disorder, and depression when compared to non-directive therapies (Bhattacharya et al., 2023). These findings suggest that while common factors matter, specific therapy techniques can play a critical role in achieving patient improvement.
What Sparked the Rise of the Dodo Bird Effect in Psychotherapy?
The Dodo Bird Effect gained attention as more forms of therapy emerged in the 20th century, each claiming to be effective. Saul Rosenzweig’s 1936 article, “Some implicit common factors in diverse methods of psychotherapy,” proposed that these approaches worked not because of their distinct techniques, but because they all shared therapeutic elements like empathy, hope, and emotional support.
As researchers sought to test which treatment was most effective, meta-analyses by Smith & Glass (1977) and later Wampold et al. (1997) revealed that most therapies had roughly equal outcomes. This reinforced the idea that similar effects might come from shared factors, not necessarily the therapy skills themselves.
What Are the Key Principles Behind the Dodo Bird Effect?
The Dodo Bird Effect centres on the concept of “common factors,” which are present in nearly all therapy models. These shared elements are believed to be the main drivers of patient improvement more so than any specific treatment technique.
Key principles include:
- Therapeutic Alliance
A strong working relationship between therapist and client is one of the best predictors of success. It includes trust, collaboration, and mutual respect. - Empathy and Emotional Support
The ability of the therapist to convey understanding and care helps clients feel safe and validated. This is consistently associated with positive outcomes across modalities. - Client Expectations and Hope
When clients believe that therapy will help, they are more likely to engage and benefit. Hope acts as a psychological placebo, influencing motivation and progress. - Opportunities for Insight and Meaning-Making
Most therapies provide space for clients to reflect on their thoughts and experiences, leading to shifts in perspective.
These principles are formally described in the Contextual Model of Psychotherapy by Bruce Wampold (2015), who argues that common factors explain the bulk of therapeutic outcomes.
What Are the Most Common Criticisms of This Theory?
While compelling, the Dodo Bird Effect is not without criticism. Many psychologists and researchers argue that it oversimplifies how therapy works and overlooks meaningful differences between treatments.
Main criticisms include:
- Overgeneralisation
The theory assumes that all therapies are equally effective, which may not hold true for specific disorders. Empirically supported therapies often outperform generic approaches. - Neglect of Treatment-Specific Mechanisms
It downplays how targeted therapy techniques (e.g. exposure in CBT for phobias) contribute uniquely to patient improvement. - Flawed Meta-Analytic Methods
Early studies cited in support of the effect did not always account for poor implementation of treatments or variability in therapist competence. - Clinical Risk
Suggesting that all therapy is interchangeable could lead clinicians to ignore established best practices, especially for serious or complex conditions. - Limited Application Across Cultures and Settings
Common factors may not have equal weight in every cultural or therapeutic context, calling the theory’s universality into question.
These critiques have led to a more balanced view that values both common factors and evidence-based treatment methods.
If All Therapies Work Similarly, Does the Type of Treatment Even Matter?
Even if similar effects are seen across many therapies, the type of treatment still matters. Factors like the therapist’s experience, the client’s preferences, cultural alignment, and the specific nature of the issue can all affect outcomes.
For instance, someone with panic disorder may benefit more from CBT than person-centred therapy, simply because one offers structured exposure techniques proven to reduce anxiety. As Wampold (2015) acknowledges in The Great Psychotherapy Debate, effectiveness depends on how well the common factors and specific skills are combined and adapted to the person not just the method on paper.
Rethinking Therapy Outcomes: What the Dodo Bird Effect Reminds Us About Healing
The Dodo Bird Effect challenges the idea that one therapy approach is superior to another, highlighting the central role of the therapeutic relationship, trust, and empathy in patient improvement. It doesn’t dismiss the value of structured treatment techniques, but it reminds us that healing often begins with connection and belief in the process.
Whether you’re a clinician reflecting on your practice, a student exploring the evolution of psychotherapy, or someone considering therapy for the first time, understanding this debate can help you think more critically about what matters most in mental health care.
If you’re curious about the broader landscape of emotional and psychological well-being, visit NeuroCog® to explore resources related to emotional clarity, mood awareness, and self-regulation. While not a substitute for therapy, tools like the Neury® App can support daily reflection and build the emotional awareness that complements any healing journey.
References:
Bhattacharya, S., Goicoechea, C., Heshmati, S. et al. Efficacy of Cognitive Behavioral Therapy for Anxiety-Related Disorders: A Meta-Analysis of Recent Literature. Curr Psychiatry Rep 25, 19–30 (2023). https://doi.org/10.1007/s11920-022-01402-8
Beck, J. S. (2020). Cognitive behavior therapy (3rd ed.). Guilford Press
Rosenzweig, S. (1936), SOME IMPLICIT COMMON FACTORS IN DIVERSE METHODS OF PSYCHOTHERAPY. American Journal of Orthopsychiatry, 6: 412-415. https://doi.org/10.1111/j.1939-0025.1936.tb05248.x
Smith & Glass (1977), Meta-Analysis of Psychotherapy Outcome Studies, American Psychologist, Sep, 1977
Wampold, B. and Imel, Z. (2015) The Great Psychotherapy Debate. 2nd edn. Taylor and Francis. Available at: https://www.perlego.com/book/1610689/the-great-psychotherapy-debate-the-evidence-for-what-makes-psychotherapy-work-pdf (Accessed: 14 October 2022).
Wampold, Bruce & Mondin, Gregory & Moody, Marcia & Stich, Frederick & Benson, Kurt & Ahn, Hyun-nie. (1997). A meta-analysis of outcome studies comparing bona fide psychotherapies: Empirically, “all must have prizes”. Psychological Bulletin – PSYCHOL BULL. 122. 203-215. 10.1037//0033-2909.122.3.203.
