Where the systems agree and disagree
After forty systems, the genuine disagreements are fewer and sharper than the vocabulary suggests.
Where nearly all systems now agree
- The relationship matters, and for some patients it is the treatment
- Avoidance maintains problems, whatever the avoidance is called
- Emotional experience must be present for change; talking about feeling is not feeling
- Early experience shapes later expectations
- Between-session life matters more than the session
- The patient’s own agency is the engine; the therapist supplies conditions
Where they genuinely disagree
| Question | Positions |
|---|---|
| Is insight necessary? | Psychodynamic: yes. Behavioural: no. Third wave: understanding the function, not the origin |
| Should thought content be changed? | Cognitive: yes. ACT and MCT: no — change the relationship to it |
| Should the therapy relationship be examined? | TFP and relational: centrally. IPT and MBT: deliberately not |
| Is the past necessary? | Dynamic and schema: yes. Solution-focused: explicitly no |
| Is diagnosis useful? | Cognitive-behavioural: yes, it selects the protocol. Person-centred and narrative: it is an act of power |
| Where does the problem live? | Individual, dyad, family, or social structure — and the answer determines everything else |
| Should distress be reduced or accepted? | Symptom-focused vs. acceptance-based, and the answer is genuinely contested |
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