re aie! Clinical Psychology ipa scotTT O. LILIENFELD Pedestal JEFFREY M.LOHRPSYCHOLOGY Science and Pseudoscience in Clinical Psychology “This unique and timely book may avert the advent of the Dark Ages into which the discipline of psychotherapy seems to be heading. By clearly articulating the fundamental dif- ferences between ‘science’ and ‘pscudoscience,’ it forewarns that anecdotes are not evidence, and demonstrates how to separate fact from conjecture. I cannot think of anyone who would not benefit from a thorough perusal of its contents, but ic is particularly essential reading for those conducting any form of counseling or psychotherapy.” —Amold A. Lazarus, PhD, ABPP, Distinguished Professor Emeritus of Psychology, Rutgers University “At last—a book that pulls no punches, names names, and isn't aftaid to portray junk science for what it is. This will be invaluable reading for anyone in the mental health pro- fessions and an essential reference for students.” —Harrison G. Pope, Jr., MD, Department of Psychiatry, Harvard Medical School The Guilford Press ISBN 1-57230-828-1 72 Spring Street New York, NY 10012 www.guilford.com 9!781572"30828;16 Toward a Science of Psychotherapy Research Present Status and Evaluation JOHN P. GARSKE TIMOTHY ANDERSON ychotherapy is the stock-in-trade of many professions, Practiced in many forms and hybrids by psychologists, physicians, clergymen, social workers, counselors, and th like, psychotherapy has been applied as a curative fora panorama of human ills and miseries. The number of psychotherapics, thei domain of application, and thei utilization by the public have in sssased dramatically over the past few decades. Ie has been estimated ce cently that there are now 250 distinee psychotherapy approaches, which ate desribed and discussed in mote than 10,000 books (Wampold, 2001). The psychotherapy professions comprise a loosely knit guild that predic aly functions to provide both service to a suffering public and self-perper- tation, ‘The proliferation of psychotherapies has fucled clashes among, para- digms, systems, and schools. With theoretical status and professional exis- tee at stake, certain psychotherapics continue to claim superiority over thc vals in the absence of definitive empirical support (Smith, Glass, Se Mis, 1980), The private and public sectors are closely serutizing the role of Psychotherapy in the provision of health care. Social critics, health ‘are managers, and policymakers are clamoring to make psjchotherapew, ‘Ne practice accountable. This climate of esis has produced a vigorous debate (cf. Wampoldy 145,Inet ms le pm fore iq fon ee fog The oad wo Gen ther fry ue £ PELE IN PSYCHOTHERAPY (ENERAL CONTFOVERSES 8 nition tha thet ge an enering recognition thatthe thorny ng 2001) The ar es analyzed and resolved BY rcance on ey frog he pr st opby, poor grounded tory Su uneptemati observa Enowledge base regarding psychotherapy anj movers 2 a change has burgeoned in recent years (Bergin & spre of gm 0 beast, the El py ecoy bas marred comet a mowed wl or gat coward shal pychowocal interven oes pctoteapy work? This question of effectiveness has lng teen the bedfllow of the field. Few, if any, professional activities the scrutinized with comparable zel and vgs than prpchotherapy ave been - dn ie raved subwaive questions regarding the effects of psych cs iiciansand researchers have provided counterpoints. The os se emi, aough troublesome for the profession, has spawned ear Mined questions and some scientifically based answers. The vet rang auexion Does psychotherapy work?—has been reconfigured harm of component questions, such a ce following: Do some psycho bth wk wad noe echcr? Which peychotherapics work the bet ‘Why? Whar are the characteristics ofan effective therapist? Does pros sonal taining and experince make 2 difference? How about genie? ‘What are the esential mredints of psychotherapies that work? Do we ow how they work? Are there negative or detrimental effects? Ths chapter wl adress these and other questions regarding the fet ofp Toward a Science of Peychetherapy Research 153 Non Nocere” (First do no harm)—pertains to. psychother: wert consensus onthe dfn ofa megane eece: eae wee paychotherapy research community. We sea numberof distinctions inthe fant be made along a continuum, staring with (1) fallre to change, that onsiificant improvements (2) abla epative change in xt wut with nonsignificant deterioration, and (3) clinically significant com ation. Most authors who have writen about “negative effects” ei deetombine the latter two definitions or focus om some form of “signili- he deterioration.” However, it is aso reasonable to assurme that lack of ca enfcant change is also a negative effect or atleast a negative Out ary er all ifthe patient does not respond to surgery, then the illness vails—clearly a negative outcome. Negative effects can occasionally be rey more revealing ofthe nature ofa study than an exclusive focus on im- Froverent. Tarrier and colleagues (2000) compared a variety of mixes of Proniive-behavioral interventions, supportive eare, and/or standard care for patients with schizophrenia, Most revealing were follow-up results, on ‘which patients in che standard care condition were shown to have deterio- fated on all of the measures Initial estimates of the rate of negative effetsdeterioration in psycho- therapy often included a mix of the aforementioned definitional criteria, which tended to be between 1/10 and 1/3 of all cases (Stricker, 1995). More recent estimates of deterioration using a more operationally formal criterion of clinically significant change indicate that “deterioration” is likely to he a much rarer occurrence. For example, Jacobson and Truax’s (1991) statistical definition of clinically significant deterioration was used in a sample of 30 patients who underwent behavioral marital therapy. Only 1 ofthe 30 patients exhibited scores that would be considered deter cxation in clinical significance terms. Of 61 patients with complete data in the Vanderbilt II psychotherapy research project, there was nota single pa- tiene with clinically significant deterioration (Bein etal, 2000). Analysis of the NIMH Collaborative Study for Depression found that only 1 of 250 patients exhibited clinically significant deterioration (Oles, Lambert, & Sawyer, 1995). Using this more clear definition of clinically significant de- teroraton, the rate of deterioration appears to be infrequent, well below 5%, atleast in these larg, carefully controlled stu. Its both fortunate—though paradoxically somewhat unfortunate— that studies demonstrate little actual deterioration within psychotherapy research. Cleary, the lack of significant deterioration, unquestionably a negative effect, reflects the fact that psychotherapy’ is highly effective tteatment fora wide range of psychosocial ils. Yet careful study of cases with deterioration has the potential ro greatly inform the fie about areas for improving psychotherapeutie practice. The majority of psychotherapy cases are more equivocal than the ‘learcut success stories that tend tobe illustrated in case reports and texts welner. CONTRIVERES IN PSYCHOTHERAPY an pa 1 feeling uncomfortable, by yay leave ables Put any pg Tis amit 2 ee responded 10 this challenge by attemping a rar Tad, and Gomera (1977) dean tre fe Sr erapy outcome. They recognized thay thay ws ese characterized bythe Unie Configure jr cijeved within any one case. Hence, native eg mes thar could be a oe pendent on the vals advocated by these three agen, MAKING SENSE OF THE RESEARCH: META-ANALYSis, | onl, compacativ investiatons of psychotherapy efficacy, sch Wer tunple and NIMH project are now myriad: The task at hand pg csc ou of many. at times seemingly disparate, scieniicfdng | Hora, scent ieratre, including psychotherapy findings ta teen eluted by means of narrative eviews in which research Inne iscompll, reviewed, and analyzed by a scholar. The pitfalls are obvon the values, biases, and preconceptions of che reviewer can significant a fect hh the seston and appraisal of the studies and the concasom Theft crete by Eyenck’s polemic and its rebutal is exemplary Sah nd Gla (1977) and Smith and colleagues (1980) deep ‘quantitative procedure for integrating the results of psychotherapy ov. Come sues tha agly eliminates the pitalls ofthe narrative een ‘Thee posed sed data that are typically availabe in published ails such means, variances, fess, Fratios, and s0 forth Ie involves an mal ysis of analyses, or meta-analysis. The primary advantage of a meta-analy 5 over a narative review is that it eeles on statistical rather than hurah Ident da ono aoa the wren of he gs The ‘otal statistic in meta-analysis i effec size, It is calculated by dividing dl So areca treated group and a control group by the stax” ig eae group. Effect size is thus a standardized mea pn ac ch map of an ct and eee pei ics using divergent proceduces and meas. sie oleae (1980) completed an exhaustive meta aas it 1766 cto cae Nt 475 Psychotherapy outcome. studies, callie toring hosands of ablations and da wih su included all published studies “hen a al be cated or derived, Various casts alyses ofthe effect-sizes provided data bearing Towerd « Science of Panctherapy Research 155 nus forms of psychotherapy produced positive out- ly this means that the av- In general, va arb effet size was .85. Stati comes, The ave comm recipient of psychotherapy is more improved than 80% of those who rat Treated. Effect size increases to .93 if placebo treatments and undif- 2 ed counseling techniques are eliminated. Such effect for psycho: therapy are comparable with those of expensive and lengthy interventions Jnimedicine and education, *y Different theoretical orientations (e.g. psychoanalytic, learning hosed, cognitive, and client-centered) and diferent modalities (verbal, Rehaviora, or expressive) did not produce different degrees or types of im- Frovement. Simple, uncontrolled comparisons of effect sizes suggested that [ipnotherapy, systematic desensitization, cognitive, and cognitive-behav- im therapies were most efficacious, but this apparent superiority van- Ithed when controlled comparisons took into account elient type and type bf outcome measure. Therapies tended to be most effective, regardless of trientation o modality, when clients with depression, simple phobias, and Snalogues of these disorders were solicited for treatment. 3 Brief versus long-term interventions, individual versus group thera~ pies, and experienced versus novice therapists yielded similar effect sizes. ‘4. Two findings temper the positive thrust of the conclusions. The generally good outcomes for psychotherapy diminish somewhat 2 years following treatment; the average effect sizes shrink to .5O, and a small per- centage of therapeutic outcomes (about 9%) are actually negative ‘The major criticism of the Smith and colleagues (1980) meta-analytic study is that it is too inclusive; using all studies necessarily requires that 90d and bad pieces of research are taken into account (e., Howard, Krause, Sanders, & Kopta, 1997). Nevertheless, Smith ct al. compared ef fect sizes on the basis of research quality. The rigor of the research had lit He oF no impact on effet size (Smith & Glass, 1977; Smith etal, 1980). ‘The results, thus, were not artifacts of including methodologically weak in- ‘estigations inthe meta-analysis. As efficacy research has burgeoned, so have the number of meta- analyses. The primary findings of Smith and colleagues (1980) have been ‘epeatcdly affirmed (Wampold, 2001). Not only does psychotherapy ‘appear to be effective, but there is litle evidence that one therapy is signi ‘antly better than another. The most comprehensive meta-analysis (Wam- pold etal, 1997) and a meta-analysis of 32 meta-analyses (Grissom, 1996) have corroborated the conclusion reached 65 years ago by Rosenzweig (1936). He characterized the apparent uniform efficacy of psychotherapies at the time as the Dodo bird verdict, after the Dodo's observation at the ‘nd of a race in Alice in Wonderland that “Everybody has won and all {ust have prizes” (p. 412). This conclusion bears profound implications forthe field of psychotherapy, which fo the past five decades has been pre-ind ms oe po fone ig foo mE PELGGPERPETECELERE & _ sees NTPOVERSES IN PSYEMOTHERAY 18 spec. ind wth nearthing the eset, 5 IES Of beh hry The vedi wo fa tha pe hs hr coon, 0 PH EAPC fen PLACEBO CONTROLS AND COMMON FACTORS ‘he Dodo bid verdict Id pychotberapy researchers 0 redouble thy Tie enly he speci and active ingredients of psychotherapy Slrapyaoeuch borowed the placebo-contol design from pet ees the hopes of partioning specific from nonspecific fciee esing atten red vo finding ways af understanding thee foe, fpoups andthe actors they were assumed to represent. Medal placebo involve psychological processes and became ofp tres to prcotberapy research because of the need to find s wenty ‘pou for oeparson mth pspchoogscl eatinents (se also Chap fora dscsion of packo eters. Beginning in the 1950s, evden ing, medial tals demonstrated that on average about 30-40% of pave who were assigned ro placebo conditions, and for which there shovid been no mesiabe improvements, often showed sig Stn og, 7) indesaning medial placebos may assist in the developmen spre componeas of prycholoial treatment. These hypotheses co tent oc patent in psychological placebo conditions whe have merece espera for reli of suffering may be much more imma amet long ae shee i Some mia Seat & noe such immediate responsiveness may ot Saarh ete eatment succes (usta is true with medical plan logical werent Placthos may achieve similar outcomes to pee 1, batches shor term hist is dscussed later n the Gp Personality paras meerte™ improvement and the correction of Be Plc compen, 1 be adesed in studies with long saci tsPerchological placehos may be more eee ho promders with eens ate heightened. Finally, psych it pipes Na std aleve quale sah ao ‘other supportive helpers, may be & tis, ‘utcomes than those who lack these qual ant reductions i seat Pxchothcray shes understood wii Tomcat of Partitioning the active ingredients "ponents: those that are specifically linked © Toward a Science of Prychetherepy Research 197 the application of psychological treatments and those that ate related to a roe general, aspects of the treatment environment and tha posses. othe perapeutic value. These latter factors have been refered to a8 com som jators because they were generally believed to be shared by all forms mlvcrapy. The difficulty of linking these factors to specific techniques of fs them nonspecific, meaning that these factors are not simply com- ine but may be harnessed and studied in their own right. Nonspecific fac- 10m Mec attributable to both patient and treatment providers and include 1eh phenomena as therapist and patient responsiveness; patent expec: aaa cathusiasm, and motivation for change; and interpersonal relation- “hip factors (Kirsch, 1997). The study ofthe therapeutic alliance i one ex- Inple of 2 nonspecific factor that has been demonstrated to exert more ‘pectic and positive influences on outcome (Horvath & Symonds, 1991; Martin, Garske, 8¢ Davis, 2000) “The main requirement of the psychological placebo group isthe inclu- «ion of some of the nonspecific factors (its now generally recognized that itis not possible for a placebo group to control forall nonspecific factors) ‘This can be accomplished through activities that mimic the treatment stud- ied including reading about psychological processes, distraction tasks, var- ious levels of clinical case management, o receiving sessions from “thera- pists” who have litle or no training in providing psychological teatments. Generally, the more a placebo group mimics the general structure of psj= chotherapy (without including any specific techniques), the more similar the effect size of the placebo to bona fide psychotherapy (Lambert & Bergin, 1994; Wampold, 2001), Furthermore, findings indicate that pa- tients in placebo groups achieve equivalent outcomes when compared with ‘hose in genuine psychotherapy (eg, Strupp & Hadley, 1979). PARAPROFESSIONALS AND EMPIRICALLY SUPPORTED THERAPIES. There have been two responses to the puzling findings tha all herapics, lespetive of therapist sophistication and_ profesional lineage, appeat Sauivlet. First there are those who view equivalent ress as evidence tha therapy, although effective, can be practiced with minimal training (se, e-2., Dawes, 1996); they see little need for doctoral training and licensure. Such advocates endorse minimal training and the increase of Paraprofessional practitioners in therapeutic settings. An implication of "cwpoin is tha psychotherapy a ts practiced i key to Become Sven more diverse andthe o sty propery. Although the fields con- ails changings more rapid alerations inthe basic stacture of psycho- Py practice result in something of 4 moving target for researchers. I early impossible to design studies that will identify these compo- will beTHIITTaRE RR _ EEEPREEEPEFEQG ELE? & ages IN PSYCHOTHERAPY ener CONTRA hiamay be ss ofa problem fr efficacy researc rit sof effectiveness research oat em for practtione research, wa al se ig pyehobery 2 i practiced i motivared in large part by managed care and oy, ee i coetrelusion, bs eores health ae reformers ations to identify treatments thar the part of professional organeza Psychi witali) o tt apport, The American Peychiatric Assocation rere I Association have spearheaded this mg than Pe cae ne Aerie Pe pivson 12 of the American Psychological Awocanga feaec crcl nme stars Hi ved therapies (once elered (0 aS “empirically map oi ap for psychological practice (American Psychological Avg at Fore, 1998) These extra ae reproduced in Tables 6.1 ae) carrie Tsk Force modeled their criteria of acceptable treatment on thes oes the Federal Drug Administration inthe attempt ro select a smal Iteofeficacious treatments from the much large list known psychothers, ios Although the Task Force itself didnot make any claims that their he Erthexapis was conclusive, twas ceaely implied that by omission a treat trent was demed as empirically unsupported. Some have argued that the shor list of psyhotherapies has passed some “standards of proo! and by implication shoud be prefered, if not mandated, for use in clinical pre tice (Nathan & Gorman, 1998). However, the list of empirically ap. ported therapies was intended tobe preliminary and updated on an anna ABLE 61. Citi for Lepr Sapored Treatments: Well Eablet 1 Ack wood wou design nudes, condiced by diferent ivesigaor, enon cry won or ore the following ways A Serer pillor phological placebo ox to another treatment Baile 19 a sad eablihed treatment in sues with aqua ssi poe OR 1 A he te of sgn dvign ues demonstrating eficacy. These wus Used good experimental designs, >: Compared the itervection to anaer treatment asin IA. theta for bah and Nicest stil ge mate deny pi oe aba Amit atm 13a oe 995,92 Capa AM Toword Science of Paycheerapy Research 199 gave 62 iter or Emily Sepoed Teams: Pb Eco Teme ae iia down Utzon mon Here dn wali etl roar on “two studies otherwise mecting the well-stablshed treatment criteria and pat both are conducted by the same investigator Or one good stady rang effectiveness by these same citra on In Atleast eo 004 studies demonstrating effectiveness but awed by heterogeneity af te lent samples. oR. Iv. small series of single-case design studies otherwise meeting the weetablihed Sekine Pc basis. The Task Force hoped to inspire new research on existing therapies as wel a to respond to the real work! marketplace dangers that surround the practice of psychotherapy. As such, the list would continue to evolve while establishing minimal standaeds of care regarding the need to provide ‘more research evidence for the practice of psychotherapy. “The movement to identify empirically supported therapies appears to run counter to our discussion thus fat. The creation of a list of empirically sopported therapies appears to be scientifically premature for the primary reason that certain psychotherapies, as long as they are bona fide forms of treatment, are likely to be equivalent to other psychotherapies (see Chapter | fora somewhat different perspective). The cumulative record of efficacy research and meta-analytic evaluations suggests as much (ef. Wampold, 2001). ‘Although we believe that the nll hypothesis of psychotherapy equiva- lence cannot be rejected, we acknowledge that others do not agree with this conclusion, On the basis of research evidence, some scholars (€.. Chambless & Ollendick, 2001; Hunsley & Di Guilio, in press) argue that «eran protocols, especially those based on cognitive behavioral approaches, ate more efficacious than others. Two counterpoints to the equivalence ‘iew are worth noting. First, there appears to be stronger evidence for the relative effects of behavioral and cognitive-behavioral interventions with reseed fvesess esearch bears (taal ions shane of he pea a 8 atl condted in the fl ge sed wt uefa only if current therapeutic Practice has ach ne rane golden standard, along with theoretical explana sae onan heap operate exact a ee fe hay propane 8 i to design “hybrid™ ekaps the best scientific strategy isto design “hybrid” studies thy se aspect ofboth lficacy and electivenss strategies wake see rely For example, Clarke (1995) suggested collecting 3 ne Jinctbaved sanple forthe purpose of performing effectiveness exesth sespen osing «subsample for & more carefully controled efficacy nett Giuke ako recommended other “hybrid” methodological stratepcy. Fey fe sagged that in sch hybrid studies, therapists be trained with mang tis but not ered to read or use chem Second, Clarke suggested thang feetivenss strategies would allow for comparison of the targeted teatneg wha standard eae condition that represents atypical mode of treatmeg inpracice, and tha this is often a much more rigorous test of a treatment toelaoes tan a placebo comparison. Third, such a strategy could as forthe combination of heterogencous (che larger effectiveness sample) ted homogeneous (the efficacy, subset sample) sampling. The advantage i that more spesifie questions, for example, about a treatment for sevete maj depresion could simakancouly be asked with questions rgarding depres son in general. A hybrid study such as that recommended by Clarke m presatly underway under the auspices of the Pennsylvania Practice Re seach Network (4e Borkovee, Echemendia, Ragusea, 8¢ Ruiz, 2001), The cffecivenss tral is completed and the efficacy component i planned. ‘The effectiveness strategy opens up powerful tools to the psychothers- By researcher, but a8 with any tol, its necessary ro understand how it used. Effectiveness research tools are most useful in developing the “tec re eee Pragmatic, relatively cay, and cos ffetve mar ner in develop these technologies and engage in empirically bred model building with relatively large sples. ‘The main reason is that much of eda ‘much ofthe effectiveness data are derived fom OF spc Being therapies that are not flly understood The bck individual kon fse3te8 design can sometimes make it more difcut for ‘© apply research findings to the treatment of indivi Toward 9 Science of Poychotherepy Research os peice amply ch ofthe ns Kesh oosety cea Mendel seep mol pr a Se a int eprom ee FE ves nw ee ge sit are curve modeling to iden three diferent types of ea Fe rr con viv coctpeelo See eee ee een iemmaies ome eee Se aka, pc alee eomgeeeehe eg ae Se re otcny wha want fete eee Sr ct an) canblesden lili eta ope ec walleye patsns OL op ap en ee \sdbhbll ee Coa oe eee fneans of identifying the type of treatment that their patient requires. See etal owneleappanciipaceate on eae Be ising lagyAaceaee Goleta oaoelegeee eee gin penipelanat mpage ecachn er eee tera begining sl ooo ape ae Te as cere inlincc pemntncher ema ee on ac coal aon peop eee ‘cians then make decisions, for example, ro change the treatment approach Pic pt aatontay ora nee Lapaprnat Erasip@aiimanta en eeesee ree rete Pie acres ts decree ee geo cles cleat Bea oot iacdnnsviicin ates ees ae nae ee eee B iirs eeatoclesueuwrictncrerime trea gt iecitssnechouhe cient oedeaeetgee fie esa dagen sich waldsseeoniecomenres ime Fleets ia psbocaty rec eoopleioott loos 1 a am to ern en nrg Cece tisk ck yo etry omens ieoneeeel Patient's significant others) or expanded to include the six outcome perspec- tives suggested by Howard and his colleagues (Howard et al., 1996)—pa- tien, client, clinicians, managers, sponsors, and researchers. Iream be asked whether the attempts to study psychotherapy can rightly be to as a science at all. What sort of truth claims can be made? Ac- to one perspective, psychotherapy may fall into a class of quesIn PSYCHOTHERAPY canara COVTROVERSES 168 tions tha are not pos ‘quent described the Serving from swer through science. Koch (1985 let ans ai extend the application of gol" need co overexrend the appl sence cory concep oes, cognitive une man ne, a I at any ee mem, mapror set of rules that conieeee? gna make Af lee vo the claims of simplistic, reductive, hy moe dee or act 7 hyper ae ar mys onolgy-storting frames, 0 longa they hay ae yea” (p 87) om is perspective pxychotherapy could be approached with anen Fa a Pd tor an erly different purpore, “Kttsagh tx important eo recognize the limitation of what ca y now pnehotherapy sa phenomenon like many others that hae cet Ronad Peat and procedures (sey the application of techniques). Avy ue by Erin (200), even subjective interpretations of client mean sting are dificult observe, but it may be possible to develop secre ee ee eg essen cota asa (oc oh eer eret pemmmaenn i hit atipl ern Cie i tael ac isd aber serwandeg ofa tut no al aspects of prychotherapy, However, itis also important tone Pee ae roenes ikcon vonch obcnical orcas presently ata basic, desriprive phase of development. ‘Causal, scientific explanation is unlikely to develop without further development ofa basic taxonamy for human change processes. A bumay chang tony moat to lees in order ok the seengicoah Clierecieipy witiea) Oneal Gt ipee shana doe treaern cheng combinations of poychotberapents veh net ‘elational processes that lead to change. This taxonomy focuses on under- Sanding wenment approach indeduly orm combination aa ee relationship to “outcomes.” This level of description could examine such sees ‘systematic desensitization lead to a significant reduc: ih peoos wih peered anc Ire deci wad ink pehterapete gsc bc logical processes. For example, might ask *" a ahs ie nls, and elnl pens ma bested te eee ‘eer reat pycoloial distance from a threatening sauation?= Con 6 these two types of questions will assist in establishing. a science of PEEPRRAOGEZES FPSPR77FFERPTE Re ] ‘The overarching issue inthis chapter pertai The oer in this chapter pertains to research metho 08%. Is the science of paychotherapy hest served by the efficacy paradig0 Toword 0 Scinco of Payhetrarapy Research 169 reiveness paradigo, oF the iotgration ofthe two? ta eesng, we she ero emphasize a approach that i citealy important for bh al Ms that could Be sed to oe the devlgment of ppc cain Qualitative research methods emphasize the detailed, ntnaoe ¥ af clinical processes. Qualitative research is expecially aneful sed 10 generate valuable hyprheses tht ean later be inethods (eg Slds, 1990), Navara sere seen absent throughout tadtlonl pychaogial re i qualeative research offers the potential nhs research pe new databases, model, and perpectives, Golde (2000) vit coz whereby researches tet sory with epg adn fc eae 10 creating numerous medificaon o main the eth ners mn cd pre hr de. gt of veenive findings of thir Own remach on mehodsoge] fi ti of to attempt t0 salvage the cheory through modification, Addi tc are then conducted, Which shen df futher metho sess and 50 OF ‘Seatauve researchers difer from traiinal reaches in that they cally are not in search of definitive answers, It is often assumed that seerapy research will advance i anawering some othe ld’ more Pere questions through new statistical procedures and better prychometrc ment (ee Stes, Shapiro, 8 Elon, 1986, However equally vet that te il cannot advance without developing more base Pes cooly including naturale obvervation, The argument male by Malate researchers that we have plunged imo rapid methodological rpeaion witout “vome ect contact with thee phenomena por te tcomenal maripulation” (Gro 1985/1992, 50, Inthe evracckrng MG or answers to what treatinen is superig, whatsype of therapy anu permis the best adherence of what component ofa eaten are tat ative when donned, cs important to remember hatte founda How of scence i the proces of formulating the right question. search a ns wich eseibes anbich of tegriy of ‘Common factors: Aspects of psychotherapy that are shared by all other po shotherapies, Common factors include many nonspecific fetors (el ft expectations) but are completely independent of specific factors fet size: The primary statistic wed in meta-analysis It often caleulated by dividing the mean difference between a treated group and a contcol group by the standard deviation ofthe contol group. ectveness research: Research on psychotherapy that is “applied” within as- tual clinical setting, im which there i less experimental contro, The oa- Sel7; CONTROVERSIES IN PSYCHOTHERAPY ed, Effectiveness reseay cing ot rat te Fer but generally less chotheeapy that is “experimental= |, randomized selection ch yy Research 00 PY in tha, arb mann By a creme ‘to be untested. ees, ng and z Be ceasteninty sete wm cumin crane on rls ae decided pon in advaec a aby cf en So erage I pearl ychaean hae derived fromthe Nae ec ocala flo fole emp af ean cam aspect of teatent. Nonspecific actors may lade nonpreseibed incrpersonal phenomena, client involvement, qq a eal expats fo change ‘Ourcome esearch: The attempt to identify the changes made at the end of, treatment or follow-up period. Process research: The attempt t0 identify the events that occur d Fe cate che seteg ee re oa ae ag reesbel eyo wirrenionne petiole hat rakes ea erode otc empoaoat Paychotherapy: A set of psychological interventions designed to help people r- cca dr dimer pd ea Ie ea ete a neil a oa fined therapeutic techniques and theoretical orientations, ‘Anerzan Pychiatrc Asociation. (1994). Di and "etl orienta) Washington,DC thor mel palit nem nel enon np pe ceo ; and tel orders. Washinon, DC: Author ie Andon EM. 8 Lambert M.}.(2001). survival analysis oil sigan Gane i oupanem psychotherapy, Journal of Clieal Paychology, 57,875 ‘ein E, Anderson, Stapp, HH, Henry WR, Schacht .E, Bide, J Lo 8 Ba ee Toward a Science of Peycheherapy Research oa {s. (2000, The le of ining nine ned dynamic pththerapy Gangs in raze outcome, Pchathrapy Rese 10 TBI gi Foca) The eiesol pychodateoyiitotaneai ak Fe eine Polos 0, 4-250," emeroaaree Jun er. Tos raloeiestcirrsens eee oe reba ed Mink of pray nd ean ap Garr York: Wey. Ae Gabe, 5 1994, Hemdbook of ppcSosbanpy iad mene se ee) Ne York Why er Boe Norn 311999 Doe pci ng eae ema) Set Dyck Bul, 8, 40107. = eet E997. The py caterapor ogee able pyr a ont rlerees othe oe of traptepcnener and aap Cle aa slog sence and Pace 444-3 pt Mato, hPa, (990) Thro al aA Cee. Garfield (Eda), Henibook of pychoterpy aed bebovor ert lp 229-269), New York Wey sun stom A Zarate Plons (200), Character oft f- oe ote napa of ts et nel ese La Fs iain of Dryreioy Cal eee pes eae Heal ng and Clnical Pycholopy 4 276-1294 nt Echemendin Ry Rape, Ay 8 Rae M 2001)-The Penny steaks Newarch Ncorork end fer posites fo cia eae Tel cndsceufaly rigorous prchoccapy elaine esearch Cla! Picbotogy Science ond Pract, 8 155-183 cae DIL, se Olendch, TH. (200), Empire supped pychologel Ieteaonn County snd eres Amal Rates of pelos 3, ase Cinerec, 8 Jcabson,N.S (1994, Who or wh) ex dopeycotherapy: The aie kad cts of nonpevnonal heripn: Pela Sc 252 13. ‘Clarke, G.I. (1995). Improving the transition from basic efficacy esearch to effec- tiveness studies: Methodological issues and procedures. Journal of Consulting and Clinical Psychology, 63, 718-725. CCrns-Christoph, P, Barnackie, K., Kutcias, J, Beck, A. T, Carroll, K. Peery, K ‘Luborsky, L., MeLeallan, A. T Woody, G., Thompson, L, Gallagher, D., & Zitsin, C. (1981). Meta-analysis of therapist effects im psychotherapy outcome Studies, Peychotherapy Research, 1, 81-91. rits-Christoph, P, 8 Mint, J.(1991)- plications of therapist effets forthe design ‘and analysis of comparative studies of paychotherapies. Journal of Consulting land Clinical Psychology, 59, 20-26. Dawes, R.M. (1996). House of cards: Psychology and psychotherapy built on myth, [New York: Fre Press. Elkin, L. (1994), The NIMH Treatment of Depression Collaborative Research Pro- fram: Where we began and where we are. In A. E. Gerbin 8S. L. Garfield (Eds), Handbook of psychotherapy and bebavior change (Ath ed pp. 114 139). New York: Wiley.PRSTARAPERZED SS PTEUP TSE RE ES ed us. (1989) ay spe BH, ENTHOVSSES N PYONTERAY rae enn 9, cour POAC Ny ew on eee it AB ein of pcb An ration. Jura Ce NS ro phot a.) Erm ay ae yy 97-725) New York Bou ea cent eba etaspocioinss New ods eas of choirs pose? American Poche Of Co. re oats Fn) B19), Puan and healing: compara andy 1 psderay (ade), Bliore Johts Hopkins Univer ree ondiee nL) Potent 8 soi cond. Pyhahay 335-341. : atl § 11996 Soe problems sociated with “aldated” orm of thay, Cla Picloy Scene ond Prati, 3, 218 223 (Gig A 1992) wade rtnlaton of pycology a chert dcp g Koch DE Lary (ln), A corey 0 pychology ac scones ee Watinon, DG AmerianPychlogal Atsocation, (Origual lished 1985) i “~ Gol M.. (2000). Cotes nprchtherapy research and rate he have all the findings gone? Psychotherapy Research, 10, 1-16, : Gola, MR. Rate?) & Canoguay, LG. 1998). The therapeu ei Stat sions of maser therapist: Acomparson of sega onet and phndamicimeteional interventions Journal of Cone inca Pca 86408810 Gea) (1986, The mal abe 7 «2: Mets-met-anayisof he ahi obapacousomeincompationsinvlvng therapy, pacer ads suite Coad Cnc Pty 4 998 98 lain AE) (197) The placebo fen terdcipbnery esplern pas Harvard University Press. et ene WP, Shc TE, Supp HH, Bute 8 Binds L193). Bes ‘teaining in me limited dynamic psychotherapy: Mediator of therapists e {ores to waning Journal of Consulting and Clinial Poychology 6, #4 Horvath, A. 0, 8 Symonds (1991). Relation berween working alliance and crema meta-analysis. Journal of Counseling Peyholoes et Xl ich ZS Lat, (1996). valuations Bi, S039. ga 7S and patient progress, American Peele doo sapling, pa sandomization, and equivalence of contract Foeblog senate, ural of Caan nd Ctl “Toward 0 Science of Peychatherapy Research 8 Glo, G. (in pres) Dodo bid, Ph ses Jo cei oF urban een? The Hr fom of pychotberapy equivalence. Scenic Review of Mental He Price rat & Hollon,S-D. (1996) Cogtve behavior hetapy versus pharma etn ence. Journal of Consulting and ClnicalPychology 64, 74-90, swt BT (1991, Cha anc Axl ppc eg meaningful change in pychotherapy reach Jounal of Cone anit 1 8 Skovholt, TM. (1999) The cogs, emesional, od rational ein eas of master therpits our of Cmmsling Pocholog t,o co i ort Worth, TX: Harcourt College. kaeslex D. J. (1966). Some myths of psychotherapy research and the search fora para- digm, Psychological Bulletin, 65, 110-136 inch (1997). Speciiying nonspecifcs:Pyshosocial mechanisms of placebo et: ‘ects. ln A. Harrington (Ed), The placebo effec: An interdisciplinary explora tom (pp. 166-186). Cambridge, MA: Harvard University Pro Kin, D.F (1996). Preventing hung juries about therapy suds, Journal of Con- iing and Clinical Psychology, 64, $1 Koch, 5. (1985). The nature and links of psychological knowledge. nS. Koch & D, E Leary (Eds), A century of psychology as science (pp. 75-97). Washington, DG: American Psychological Assocation. Lambert MJ 8 Bergin, AE, (1994), The effetivenes of psychotherapy. nS. Gar- ficld & AE, Bergin (Eds), Handbook of psychotherapy and behavior change (pp, 143-189), New Yorks Wiley Lakers, L, (1954). note on Eysenck’s article, “The lfc of pychotherapy : An saluation.” British Journal of Psychology, 45, 129-131, Laborshy, L. Crits-Christoph, P, MeLellan, T, Woody, G., Piper, W, Imes, 8.8 Liberman, B. (1986) Bo therapists vary much ia Hose? Findings Eom four outcome studies. American Journal of Orthopsychiatry, 56, $0\-S12. LuborskyL McLellan, AT, Digut L, Wood, G.€Seligman,D.A. (1997) The Pychotherapst matter: Comparison of ostcomeacromstwenty-two thera ists and seven patent samples, Clinical P ‘Science and Practice 4, te P: pls, sycholony: ‘yn SJ, 8eGarske, J.P (1985). Contemporary psychotherapies: Models and meth- ‘ods (pp. 316). Columbus, OH: Meri. NallnckrodB, & Nelson, M.L (1991), Counselor taining level andthe forma- tion of the psychotherapeutic working lance. Journal of Counseling Paychol- 43,38, 135-138, sD. J, Garske, oP, 8 Davis, M.K. (2000), Relation of the dherapeutic ali ance wth outcome and other vatsbles A mets-anaytic review. Journal of Con- fit and Cltical Psychology, 63, 438-450. fan & Gorman, JM, 1998) Aga to ements tat work New York: ed University Press. +B.M.,Lambert, MJ, 8 Sawyer, JD. (1995). Cnc significance of the NaPEPERG PERSE RS ed LEGPEEPIERPRE2GH F [GENERAL CONTROVERSES IN PSYCHOTHERAPY 174 rl Mental Health Treatment of Depression Co {Insitute of Mental Health Ts a th Program dts, Journal of Consulting acd Clinical Peycpnn 2? arch Program dts J n rat ‘l or 1999)The maser therapist: Leal ch isk, DE (1999). The master therapist: Le ton on rinandgpmcnor gsr Thecop ‘elabonal characteris of mater therapists Jonna of Coun Pa 04, 46, 12-15. “ tof nigh desenstiation, ad attention play Pe prof ay Su Sanfr Unnerty re Ho ks. Thomas A & Ro M1974 Lf itor research pyc Pll Minseapoic University of Minoesoa Pree "hone Rosetti S936) Some impli common factors im dvr therapy: -Atlatthe Dodo si, Fverbody hae won and. American Journal of Onhopsyciatry, 6, 12-415 Selma, M. EP (1995), The efetivenes of psychotherapy arts survey. American Pechologis, 50, 968974 Selgnan, ME (1998). Aferwor. InP. Nathan treatments tht work (pp. SE8-S72), New Yo Seligman, M.E-P,& Levant RE (1998) Managed care pli sens. Profesional Pychology: Research and Practce 99,0) Sous; Sale R Cito, H, York, NJ Whipp sy Ech era ba ry Cade MA Vata Seith M1. 8 Gla, GV. (1977). Metwanalyss of is. American Pycholoit, 132, 752-760 Smith MCL, Gls GV Mile TL (1980), The benefits of oychother ‘io: Johns Hopkins Univers Press. eof veiana Se 5 (99) The hapten ln R.A. Well SV. Gamen seas ribo th rit pycoterapie(pp.27-53) New Yor Maney ls WB. Shapiro D.A. & Eliot R. (1986) Arcallpychothenpe neg American Peychlog, 4, 165-180, eres Seeks (1995) Falun pychotherapy Journal of Pochotherpy leprae, Srp 8 Anderson (197), On the lmitations of therapy manual ‘al Pochlogy: Since and Prachi, 4, 76-82, aon Serop, HH. Hadley, SW. (1979) 5 am, Archies in General Paychistry, 36, 1135-1156, ‘Serupp, H. H., Hadley, S. W, & Gomes Schwartz, B. (1977). Psychotherapy for ‘Aron, A Ar anlyisof the problem of negative affects New Yok oe Tis N; Kiser McCarty E, Humphrys, Wiskowsi, A, 8 Mai (2000 of cognitive behavioral therapy and spe Persistent symproms in chroncschaepies of Consulting and Clint Pychology, 68, 917-992 Tat AH 997 Ap ‘New York: Wie. se method, alma have Pras The Consumer & J. Gorman (4s), 4 rk: Oxford University pee 1 om nadeune Psychotherapy outcome Pecific vs. nonspecific factors in paychoti Psrchopathology and diagnosis |Srdeb) Tower © Bees ot Preterm, tarpold B.F.(2001). The great pe 178 srchotherapy debate ngs, Mahwab, NJ: Erihaum, 7 hte Models, metdy an fin Mond, G. W Moody, 5 fatwa ote as Sth Ben KA ry pareally “all must have prizes." Pryebolagea nt ie chores scbologcal Balen weserman, M.A. Foote, JP, 8¢ Winston A (1995) eae 22s 200215 ‘phases of psychotherapy and out forthe role nen et contbton we han ener = ology. 63 672-675 nal of Conn