From Dodo Bird to Mindfulness: The Effect of Theoretical Orientation
on Work and Self
Nathan T. Pruitt
Siena College
I discuss my transformation from a confused graduate student with a common factors theoretical
orientation to a licensed psychologist focused on humanistic, cognitive, and mindfulness approaches.
My theoretical journey was shaped by my work with clients and my own personal development and
primarily motivated by a sense of uncertainty that accompanied the lack of a specific theoretical
identity. This discussion of trying to find the “right” theoretical approach is set against the wellsupported empirical findings that theoretical techniques (i.e., “specific factors”) contribute relatively
little to clinical outcome, and that no single theoretical approach has distinguished itself as superior to
others in the literature. I discuss the effects of my theoretical orientations on my work with colleagues,
C 2014 Wiley Periodicals, Inc. J. Clin. Psychol.: In
my relationship with my spouse, and being a parent.
Session 70:753–759, 2014.
Keywords: dodo bird; humanistic therapy; cognitive therapy; mindfulness
Wrestling With the Dodo Bird
A few months after I completed my doctorate, I attended a wedding reception where I was asked
by one of the guests about my work as a psychologist. She was a young woman with an interest
in the field, and she asked an obvious question: “So how exactly do you get people to change
their behaviors? How do people actually get better?” It was a question tailor-made to offer one’s
own theoretical perspective on change, psychological disorders, and recovery. The question,
however, caught me off guard, as I knew there was no agreed-upon answer. A good part of
my confusion also arose from the well-replicated and robust research findings that have shown
that no one theoretical orientation is more effective than another (Duncan, Miller, Wampold, &
Hubble, 2010; Hubble, Duncan, & Miller, 1999). It was this finding that the psychologist Saul
Rosenzweig called the “dodo verdict,” after a character in Alice in Wonderland (Duncan, 2010).
The dodo, judging a chaotic race between animals, proclaimed, “Everyone has won, and all must
have prizes” (Carroll, 1869, p. 34), which Rosenzweig thought perfectly summarized the research
on psychotherapy outcomes (Duncan, 2010). The dodo bird verdict makes for an interesting
discussion at an academic conference or graduate seminar, but it is quite inconvenient when
trying to explain how psychotherapy works to someone at a wedding. My reply to the wedding
guest was my own personal theory of change at the time, which came out as working alliance
(goals, task, and bond), humanistic psychotherapy, and unnamed “therapeutic techniques.”
That conversation stuck with me, as I was still working through my theoretical orientation,
despite having nearly finished my postdoctoral fellowship at a large university counseling center.
The dodo bird verdict was a source of personal frustration. I wanted to pick “the best” theoretical
orientation that was supported by current scientific literature. I wanted to feel that I had the tools
to handle my clients’ issues with precision and confidence, and that psychotherapy itself was as
much science as art. A sizeable base of research had demonstrated that psychotherapy indeed
worked, often better than common medical interventions (Hubble, Duncan, Miller, & Wampold,
2010), but I felt that if I did not know how it worked, I would be a less effective psychologist.
So, by the middle of my fellowship, I had a vague theoretical approach consisting of a little
humanism, the beginnings of cognitive-behavioral therapy (CBT), and other transtheoretical
Please address correspondence to: Nathan Pruitt, Siena College, Center for Counseling and Student Development, 515 Loudon Road, Foy Hall, Room 110, Loudonville, NY, 12211. E-mail: npruitt@siena.edu

C 2014 Wiley Periodicals, Inc.
JOURNAL OF CLINICAL PSYCHOLOGY: IN SESSION, Vol. 70(8), 753–759 (2014)
Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.22110
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Journal of Clinical Psychology: In Session, August 2014
approaches (e.g., working alliance, stages of change). While that was better than where I was
early in graduate school, when I was using very little coherent theory in counseling, I was
still not satisfied with my ideas about how people change in therapy. It would take me several
more years after my fellowship to refine my theoretical approach and discover why I thought that
approach was “right.” What I realized through this process was that my selection of a theoretical
orientation was based not only on my reading of the theoretical and empirical literature, but
also on how I understood myself.
Why Have a Theoretical Orientation?
I started wrestling with the dodo bird early in graduate school. Compounding my struggle
was the discouraging finding that “specific factors” (i.e., techniques derived from a particular
theories used in real clinical cases) contribute to only 1% of therapeutic outcome (Wampold,
2001). I knew that multiple meta-analyses had shown that the psychotherapy relationship was
the single largest contributor to clinical improvement (Duncan et al., 2010; Hubble et al., 1999),
but that knowledge was not helping much either. I imagined taking my car to an auto mechanic
and having him tell me, “It doesn’t matter how I fix your car. What matters is that we have a good
relationship.” Though translating that statement to the world of therapy sounded odd to me, I
was not going to argue with the research about the importance of the therapeutic relationship.
Maybe it did not matter “how I fixed the car” as long as I cared and tried really hard to help. So,
as a wise graduate student, I devoted most of my energy to “relationship building” with some
practical problem solving thrown in. I would rarely mention any particular theory or approach
and instead talk about the value of psychotherapy as a place to “figure things out” with a
neutral third party. Aside from the healing presence of a supportive and patient person and
general problem-solving strategies, I also gently suggested improving self-care (eating, sleeping,
exercise), broadening social support networks, and communicating one’s needs to friends and
family. For good measure, I also assessed each client’s “stage of change” (see Prochaska &
DiClemente, 1992) and tried to nudge them in the direction of taking action.
My approach early in my doctoral training was a grab bag of ideas that did not hold together
in a cohesive way. For quite some time, that lack of cohesion really did not bother me. I received
good evaluations from supervisors and clients at my practicum sites. When asked to explain my
approach in graduate school essays, I would say something like “transtheoretic biopsychosocial,”
which is the kind of thing that can only make sense to you if you have done a lot of reading
about therapy and very little actual therapy. Part of the problem for me was that theory-based
approaches had not clicked for me in coping with my own worries. The strategies I believed in
most were what I was most comfortable offering to my clients (e.g., self-care, using your support
system). My general lack of a theoretical orientation, however, did not leave me well prepared to
handle more severe problems like personality disorders, eating disorders, or substance abuse. I
recall reading the evaluation from one such client, a college woman struggling with bulimia who
dropped out of treatment after four sessions. She wrote of her time with me: “He was a really nice
guy, but he just didn’t seem to know how to help me.” Ouch. I discussed the evaluation with a
colleague who said, “You just can’t win with some clients,” before sharing her own disappointing
client evaluation. I felt I needed a better grasp of theory to confidently offer more strategies to
my clients.
By the time I realized that I needed to invest time and energy into theory, I was ready to apply
for predoctoral internships at college counseling centers. The application process forced me to
examine the kind of therapist I wanted to be, and I was finally able to put the dodo bird in its
proper place. Namely, though research showed that all the theories and associated techniques
produced similar results, this did not mean that I could altogether forgo structure in counseling.
In working alliance terms, I seemed to do well with forming empathic relationship bonds with
my clients and setting goals, but I needed to work more on the third aspect of the alliance–the
“tasks” of therapy–as I knew that having a strong overall alliance was correlated with better
treatment outcomes (Horvath & Symonds, 1991). Many of these tasks would be determined by
my theoretical approach.
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Also, I realized that to have confidence in my own work, I needed to commit to a system of
therapy, as I felt little sense of mastery with my current approach. In other words, as stated by
Sparks and Duncan (2010), “The clinician must have a model in which to place his or her faith
(one hopes many models), and a rationale and ritual is required to satisfy the client’s expectation
that he or she is being treated by a credible psychotherapist” (p. 373). I needed to find my model,
so I resolved to learn more about the theories to which I was drawn and go from there.
Relearning Rogers
The theory that appealed to me the most was Carl Rogers’ humanistic psychotherapy, about
which I had read many summaries and critiques but very little actual source material. When I
thought about problems I had faced in my own life, and about my experiences in addressing
those problems, I imagined someone who genuinely cared about me to help me sort myself out.
I appreciated the supervisors I had who could be with me during vulnerable moments, how they
normalized those struggles, and how they encouraged me. So, I read On Becoming a Person
(Rogers, 1961) and other of Rogers’ works. Rogers (1961) summarized how I felt about therapy:
“The more I am open to the realities in me and in the other person, the less do I find myself
wishing to rush in to ‘fix things’” (p. 23).
I wanted therapy to be about openness and healing as opposed to finding a “right answer”
for each client, which fit with Rogers’ feeling that the attitude of the therapist (specifically:
acceptance, genuineness, and unconditional positive regard) was more important than any
specific techniques (Kirshenbaum & Henderson, 1989). So, for a time, as I explored my clients’
conditions of worth and provided positive regard, I thought I would be able to help everyone, so
long as I was patient and really cared. The approach did not, in practice, differ much from what
I was doing before, but I was much better at describing it to clients and getting them to “buy
into” counseling. By the time I started my predoctoral internship, I was a committed Rogerian.
Adding CBT
Unfortunately, pure humanistic theory and practice do not fit well with session limits that
are the reality of many counseling centers and insurance-driven work. As noted by Prochaska
and Norcross (1999), “Rogers’ own therapy cases almost always ran into two-digit numbers
of sessions and frequently went into three digits” (p. 152). We had a 10-session limit at our
counseling center, and apparently nobody wanted to change these limits just because I enjoyed
humanistic psychotherapy. Additionally, some clients wanted actions they could take in the
short-term, and I worried that, in response to these clients’ requests, my suggestions of relaxation
techniques, exercise, and other steps did not flow smoothly from humanistic theory. I had noticed,
as well, that several clients requested cognitive-behavioral therapists when filling out their intake
paperwork, and that these colleagues were some of the most respected therapists at my internship
site. By the time I started my postdoctoral fellowship, I felt I needed more tools to offer my
clients, so I resolved to learn more about CBT.
I had previously been resistant to CBT, as I felt it was too mechanistic. As someone who
worried about almost everything much of the time, I felt I needed less thinking and rationality,
not more. As Judith Beck (2011) said, however, if you cannot endorse the fundamental framework
of CBT, “You may need help from a supervisor to respond to your automatic thoughts about
the patient, about cognitive behavior therapy, or about yourself” (p. 18). Though I did not read
Dr. Beck’s book until years later, I did have a feeling at the time that my “automatic negative
thoughts” had led me to be too dismissive of CBT. Half of my colleagues used the approach, and
many of those therapists were quite confident it was the best way to do therapy. So, I worked with
my supervisors and started using CBT workbooks. I soon began to enjoy prioritizing problems,
testing hypotheses, challenging clients’ negative core beliefs, and, in general, conducting more
structured therapy sessions.
Like humanistic counseling, I also appreciated CBT more when I realized it could help with my
own issues with unreasonable personal expectations that left me feeling inadequate, particularly
when clients did not make much progress. CBT techniques helped me take the edge off of these
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Journal of Clinical Psychology: In Session, August 2014
thoughts by countering my irrational thinking with such thought challenges as “You are still
learning and uncertainty is normal” and “Even the best therapists have clients who don’t get
better.” Because CBT helped me, I was more enthusiastic about implementing these strategies
with clients. As Dr. Beck advised in her book, Cognitive Behavior Therapy: Basics and Beyond,
“Using yourself as the subject will enhance your ability to teach your patients these same skills”
(p. 14). After all, if the techniques didn’t help me, it would have been much more difficult to
recommend them to someone else.
Becoming More Mindful
I continued to use a mix of CBT and humanistic counseling for several years in my first professional job at a university counseling center. Though I felt I was doing good work, there were
clients who needed more than just a good listener but who still would not buy into CBT no
matter how much I tweaked my approach. Also, on a more personal note, my spouse and I had
our first child at that time, and nothing creates more automatic irrational thoughts about being
inadequate than parenting. Am I a good dad? Will my daughter figure out I don’t know what
I’m doing? Will my daughter resent me for working full-time? Suddenly, I couldn’t summon
enough rationality to combat my irrational thoughts. I didn’t want to discard CBT, but I needed
something new.
A few of my colleagues had started a mindfulness group for interested staff members, and
I went to some sessions. I was interested in the approach and did some reading, but it would
take another couple of years before I enrolled in a weeklong seminar with Dr. Ron Siegel, an
authority on mindfulness and meditation in psychotherapy. His (2010) book, The Mindfulness
Solution, made sense to me in a way that CBT never quite did. Summarizing decades of research
and thousands of years of philosophy, he wrote, “Thinking and planning, wonderful and useful
as they are, are at the heart of our daily emotional distress because, unlike other tools, we can’t
seem to put these down when we don’t need them” (p. 10).
Addressing CBT more directly, Siegel argued that “our thinking habit is very strong and
our attempts to stop it are futile” (p. 121). Namely, through meditation, I tried to notice and
observe my thoughts before letting them all go (not just the irrational ones). Meditation did
not come naturally to me, but I enjoyed it and found “letting go” more intuitive than trying
to rehearse thought challenges. I started meditating on a regular basis (though not as regular
as I would like). Meditating has even helped with my perfectionism, though I still catch myself
trying to be a “perfect meditator,” a complete oxymoron of course. Implementing meditation
with college students has been slightly more challenging, as it is hard for this group to find the
time and personal space for regular practice amidst their many obligations. Fortunately, using
a meditation and mindfulness approach with some clients did not preclude the use of CBT with
others. As for me, meditating is refreshing, and mindfulness has become the theoretical approach
that has added the most to my own life.
Theory and My Colleagues
Though I have struggled for years about which theoretical orientation was best for my clients,
my mental health colleagues were usually tolerant of whatever my theoretical perspective was
at the time. After all, they had theoretical perspectives too, and they wanted to be respected as
competent professionals. For many of my nonmental health colleagues, however, the choice was
clear all along: CBT was always the runaway favorite. After I started telling people that I was
moving toward CBT during my postdoc, I started getting referrals from individuals from whom
I had never received a specific referral. That pattern–that is, that approval–occurred in other
areas of my professional life as well. CBT made intuitive sense to other university professionals
(e.g., deans, professors, residence life staff) who worked with the counseling center regularly, and
that reaction, in turn, helped them have more confidence in referring students to our center (or
to me).
That reaction just did not happen when I used terms like humanism, stages of change, or
mindfulness. For example, I still recall my surprise at an interaction I had with a university
Theoretical Challenges
757
physician. The physician and I shared a patient, and the patient told the physician that she
was pleased she went to the counseling center and worked with me because she was doing “so
much better.” The physician told her, “That’s because he works from a CBT perspective. Lots of
evidence to support that.” I didn’t argue with the physician or her compliment (which seemed
to me like a poor strategy for increasing our health services referrals), but I was shocked by
the power she attributed to CBT. In contrast, though I have worked only with mindfulness
for a few years, the reactions I have received tend to be of two types. Some health professions
and university staff react with great excitement: “Hey, I meditate too!” Others seem tolerant but
slightly puzzled, as if they missed the last division meeting where I had announced my conversion
to Buddhism.
To this day, I always explain my CBT approach first before adding anything else about my
theoretical approach. Perhaps CBT does not work better than other theories, but if that helps
get referrals for the counseling center or instills greater hope or confidence in clients, then why
argue with results?
Theory, My Spouse, and My Children
While I have embraced CBT at work, mindfulness and humanistic approaches have been the
theoretical approaches that have had the largest effect on my relationships with my spouse and
kids. Though I have more readily noticed the effect of mindfulness, as it is still new to me,
both approaches guide my everyday relationships, albeit in different ways. The usefulness of
mindfulness became apparent after we had our first child. My spouse’s job as a subspecialized
surgeon is demanding and requires many late nights at the hospital. Given the demands of
her career, I do the majority of the childcare in our relationship. I spend my nonworking
hours cooking dinners (“How about macaroni again tonight?”), going to swimming lessons, and
trying to keep my kids from injuring themselves (or each other). Most people who have spent
any amount of time around little kids would probably agree that although they can be cute and
amazing, they also could be exhausting and frustrating. Here, mindfulness has helped me be
more patient and not overreact to whatever they are doing in the moment. As Siegal (2010)
noted:
Mindfulness practice helps us provide holding for our children in two ways. First, by
helping us pay attention, it helps us read their communications more accurately . . . .
Second, mindfulness practice increases our capacity to bear discomfort. (p. 238)
If you’ve ever struggled to convince a 2-year-old that, yes, she really does need to wear pants or
watched your 4-year-old cry because you put too much tomato sauce on her pasta, you definitely
know discomfort. As I have gotten more into meditating and mindfulness, I am better at sticking
with the situation and helping my kids instead of giving up (“Ok, we just won’t go to the grocery
store”) or getting irritated. This external mindfulness helps me to stay “present, aware, and
attuned to what is occurring in the environment” (Goodman, Greenland, & Siegel, 2012, p. 299)
and results in my having more patience with my children. Additionally, once I realized that–“The
younger the child, the more the boy or girl lives in the present moment” (Siegal, 2010, p. 240)–I
interpret their willfulness as developmentally normal, not an affront to my parenting skills. I will
never be a perfect parent, but meditation has made me more appreciative and understanding of
day-to-day life with my two funny and fun daughters.
Adopting humanistic approaches in my practice has also significantly affected my relationships. The effects are subtler than those of mindfulness, largely because I see Rogers’ approach as
an extension of my own naturally occurring personality. For example, going back to high school,
I already valued accurate empathy and positive regard (without knowing what they were, really)
and felt these approaches helped me connect and form strong relationships with friends and
family. Reading and practicing Rogers, however, produced additional benefits that went beyond
my inherent personality. Two examples stand out clearly to me. First, Rogers often discusses the
benefits of unconditional positive regard, which I had loosely interpreted, before really reading
Rogers, as being supportive and encouraging to other people (which comes pretty easily to me).
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Journal of Clinical Psychology: In Session, August 2014
Rogers also emphasized, however, that part of positive regard was being cautious about giving
advice, as that can come off as disapproval of the client, condescending, or both. As he states
(1972), “The dangers of advice stand out so very clearly . . . . How easy it is to direct the life of
another and how very difficult it is to live your own!” (p. 189). Well said!
Rogers’ advice here saved me on many occasions with clients and family members alike. I
recall working with a college-age woman in a physically abusive relationship. There were times
in session I literally had to bite my lip to avoid jumping in with obvious suggestions about how
poorly she was being treated, that she could do better, and so on. The client, however, had already
heard all of that advice from friends, roommates, siblings, and even staff at the university. What
she needed from me was a caring presence and space to allow her to make a difficult decision
about how to proceed with her relationship. I gave her space to process her confusion, and she
eventually decided to leave the relationship. The same dynamic has helped when family and
friends make different choices from what I think would be “best” for them. Instead of jumping
in with well-intentioned but probably not that helpful advice, I am patient, which is possible
only through empathy for different worldviews other than mine.
A second way in which Rogers has helped my personal relationships, particularly those with
my spouse and my children, is through his emphasis on genuineness (congruence). He writes
(1972), “One rule of thumb which I have found helpful for myself is that in any continuing
relationship, any persistent feeling had better be expressed. Suppressing it can only damage the
relationship” (p. 196). Rogers felt this was important in all relationships form many reasons,
with one of the main reasons being that when one communicates genuinely (i.e., affect matches
actions), others are more trusting that you are communicating sincere feelings. As he writes in
On Becoming a Person (1961):
To conclude our definition of this construct in a much more commonsense way, I
believe all of us tend to recognize congruence or incongruence in individuals with
whom we deal. With some individuals we realize that in most areas this person
not only consciously means exactly what he says, but that his deepest feelings also
match what he is expressing . . . . With another individual we recognize that what
he is saying is almost certainly a front, a façade. We wonder what he really feels.
(p. 342)
Obviously, there are times when sharing one’s true feelings is incompatible with providing
unconditional positive regard, but I have found that when I did not express my feelings of anger,
disapproval, or disappointment in some way in a friendship, the relationship eventually fizzled.
I realized (in some cases, many years later) that I might have missed opportunities to salvage a
damaged relationship by being more open to expressing these feelings. So, in my relationship
with my spouse (which, frankly, has usually been extremely positive), we are both open with
each other in our disagreements. By doing so, we are congruent within ourselves and with each
other, a process which continues to maintain an honest and rewarding relationship.
Putting It All Together
When asked to identify my theoretical orientation now, by either colleagues or clients, I report
happily that I’m an integrative therapist that uses CBT, humanistic, and mindfulness approaches.
I feel that each additional element has made me a better therapist, friend, spouse, and parent.
I say this knowing that the research demonstrates that there is “no evidence to support the
claim that removing or adding a specific ingredient to a treatment altered outcomes” (Wampold,
2011, p. 62). Hubble et al. (2010, p. 28) were even more direct: “Bluntly put, the existence
of specific psychological treatments for specific disorders is a myth.” Maybe my addition of
new approaches and techniques really did not make me a better therapist. Maybe in the end,
however, what matters is that I feel more confident in applying theory with my clients, and that
they, in turn, have more confidence in me. With regard to my own relationships, mindfulness
and Rogerian approaches have made observable and concrete differences in how I interact with
the most precious people in my life.
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All this progress on my theoretical orientation and in my personal relationships has left me
looking forward to the next wedding conversation about psychotherapy. This time, I know I will
answer with confidence.
Selected References and Recommended Readings
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). New York: The Guilford Press.
Carroll, L. (1869). Alice’s adventures in wonderland. Boston, MA: Lee & Shepard.
Duncan, B. L. (2010). Saul Rosenzweig: The founder of common factors. In B. L. Duncan, S. D. Miller, B.
E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works in therapy
(2nd ed., pp. 3–22). Washington DC: American Psychological Association.
Duncan, B. L., Miller, S. D., Wampold, B. E., & Hubble, M. A. (Eds.). (2010). The heart and soul of change:
Delivering what works in therapy (2nd ed.). Washington DC: American Psychological Association.
Goodman, T., Greenland, S. K., & Siegel, D. J. (2012). Mindful parenting as a path to wisdom and
compassion. In C. K. Germer & R. D. Siegel (Eds.), Wisdom and compassion in psychotherapy (pp.
295–310). New York: The Guilford Press.
Horvath, A. O., & Symonds, B. D. (1991). Relation between working alliance and outcome in psychotherapy:
A meta–analysis. Journal of Counseling Psychology, 38, 139–149.
Hubble, M. A., Duncan, B. L., & Miller, S. D. (Eds.), (1999). The heart and soul of change: What works in
therapy. Washington DC: American Psychological Association.
Hubble, M. A., Duncan, B. L., Miller, S. D., & Wampold, B. E. (2010). Introduction. In B. L. Duncan, S.
D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of change: Delivering what works
in therapy (2nd ed., pp. 421–429). Washington DC: American Psychological Association.
Kirschenbaum, H., & Henderson, V. L. (Eds.), (1989). The Carl Rogers reader. Boston, MA: Houghton
Mifflin Company.
Prochaska, J. O., & DiClemente, C. C. (1992). The transtheoretical approach. In J. C. Norcross & M. R.
Goldfried (Eds.), Handbook of psychotherapy integration. New York: Basic.
Rogers, C. R. (1961). On becoming a person: A therapist’s view of psychotherapy. Boston, MA: Houghton
Mifflin Company.
Rogers, C. R. (1972). Shall we get married? In H. Kirschenbaum & V. L. Henderson (Eds.), The Carl Rogers
reader (pp. 153–197). Boston, MA: Houghton Mifflin Company.
Siegel, R. D. (2010). The mindfulness solution: Everyday practices for everyday problems. New York: The
Guilford Press.
Wampold, B. E. (2010). The research evidence for common factors models: A historically situated perspective. In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds.), The heart and soul of
change: Delivering what works in therapy (2nd ed., pp. 49–81). Washington DC: American Psychological
Association.
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