Despite the growing influence of lists of empirically supported therapies (ESTs) there are concerns about the design and conduct of this body of research. These concerns include limitations inherent in the requirements of randomized control trials (RCTs) that favor those psychotherapies that define problems and outcome in terms of uncomplicated symptoms. Additional concerns have to do with criteria for patient selection, lack of integration with research on psychotherapy process and effectiveness studies, limited outcome criteria, and lack of controls for experimenter bias. RCT designs have an important place in outcome research; however it is important to recognize that these designs also place restrictions on what and how psychotherapy can be studied. There is a need for large scale psychotherapy outcome research based on designs that allow for inclusion of process variables and the study of the effects of those idiographic approaches to therapy that do not lend themselves to RCT designs. Interpretative phenomenological analysis may provide a useful method for the evaluation of the effectiveness of idiographic approaches to psychotherapy where outcome is not understood solely in terms of symptom reduction. 1. Introduction There are several issues related to the external validity of lists of empirically supported psychotherapies (ESTs) that should be considered before broad policy changes are instituted based on this body of research. First, the design requirements of randomized control trial (RCT) studies do not allow for adequate understanding of the multifaceted nature of many mental health problems or the complex interplay of individual differences, interpersonal processes, and range of potential outcomes that are inherent in psychotherapy practice. Second, the EST literature is based on studies characterized by unacknowledged sampling issues, methodological constraints, researcher bias, and limited outcome criteria [1–3]. 2. Background A white paper issued by a Task Force of the American Psychological Association in 1995 stated that “in order to remain competitive in the mental health services marketplace psychologists must provide evidence of therapeutic efficacy in the form of lists of empirically supported psychotherapies (ESTs) for specific disorders” [4]. The APA paper specified RCTs as the ideal design for studies of psychotherapy efficacy, in which “a treatment is manualized and demonstrated to be more effective than other treatments or placebo” [4]. A large number of efficacy studies have been published that are the basis for lists of ESTs
References
[1]
B. Wampold, “Do therapies designated as ESTs for specific disorders produce outcomes superior to non-EST therapies? Not a scintilla of evidence to support ESTs as more effective than other treatments,” in Evidence-Based Practices in Mental Health: Debate and Dialogue on the Fundamental Questions, J. C. Norcross, L. E. Beutler, and R. F. Levant, Eds., pp. 299–308, American Psychological Association, Washington, DC, USA, 2005.
[2]
D. Westen and K. Morrison, “A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies,” Journal of Consulting and Clinical Psychology, vol. 69, no. 6, pp. 875–899, 2001.
[3]
D. Westen, C. M. Novotny, and H. Thompson-Brenner, “The empirical status of empirically supported psychotherapies: assumptions, findings, and reporting in controlled clinical trials,” Psychological Bulletin, vol. 130, no. 4, pp. 631–663, 2004.
[4]
American Psychological Association Task Force on Psychological Intervention Guidelines, Template for Developing Guidelines: Interventions for Mental Disorders and Psychosocial Aspects of Physical Disorders, American Psychological Association, Washington, DC, USA, 1995.
[5]
D. L. Chambless and T. H. Ollendick, “Empirically supported psychological interventions: controversies and evidence,” Annual Review of Psychology, vol. 52, pp. 685–716, 2001.
[6]
D. Barlow and J. Carl, “The future of clinical psychology: promises, perspectives, and predictions,” in The Oxford Handbook of Clinical Psychology, D. H. Barlow and P. E. Nathan, Eds., pp. 891–911, Oxford University Press, New York, NY, USA, 2011.
[7]
P. A. Arean and H. C. Kraemer, High Duality Psychotherapy Research: From Conception to Piloting to National Trials, Oxford University Press, New York, NY, USA, 2013.
[8]
K. F. Schulz, L. Chalmers, R. J. Hayes, and D. G. Altman, “Empirical evidence of bias: dimensions of methodological quality associated with estimates of treatment effects in controlled trials,” The Journal of the American Medical Association, vol. 273, no. 5, pp. 408–412, 1995.
[9]
F. Richardson, B. Fowers, and C. Guignon, Renewing Psychology: Beyond Scientisim and Constructivisim, Jossey-Bass, San Francisco, Calif, USA, 1999.
[10]
R. Frie, Understanding Experience: Psychology and Postmodernism, Routledge, New York, NY, USA, 2003.
[11]
J. Martin and J. Thompson, “Psychotherapy as the interpretation of being: hermeneutic perspectives on psychotherapy,” Journal of Constructivist Psychology, vol. 16, no. 1, pp. 1–16, 2003.
[12]
E. Ansell, A. Pinto, M. O. Edelen et al., “The association of personality disorders with the prospective 7-year course of anxiety disorders,” Psychological Medicine, vol. 41, no. 5, pp. 1019–1028, 2011.
[13]
B. E. Wampold, “Psychotherapy: the Humanistic (and Effective) Treatment,” The American Psychologist, vol. 62, no. 8, pp. 857–873, 2007.
[14]
D. Westen, “Are research patients and clinical trials representative of clinical practice?” in Evidence-Based Practices in Mental Health: Debate and Dialogue on the Fundamental Questions, J. C. Norcross, L. E. Beutler, and R. F. Levant, Eds., pp. 161–171, 317–319, American Psychological Association, Washington, DC, USA, 2003.
[15]
M. T. Shea, I. Elkin, S. D. Imber et al., “Course of depressive symptoms over follow-up: findings from the national institute of mental health treatment of depression collaborative research program,” Archives of General Psychiatry, vol. 49, no. 10, pp. 782–787, 1992.
[16]
P. Knekt, O. Lindfors, T. H？rk？nen et al., “Randomized trial on the effectiveness of long-and short-term psychodynamic psychotherapy and solution-focused therapy on psychiatric symptoms during a 3-year follow-up,” Psychological Medicine, vol. 38, no. 5, pp. 689–703, 2008.
[17]
P. Knekt, O. Lindfors, M. A. Laaksonen, R. Raitasalo, P. Haaramo, and A. J？rvikoski, “Effectiveness of short-term and long-term psychotherapy on work ability and functional capacity—a randomized clinical trial on depressive and anxiety disorders,” Journal of Affective Disorders, vol. 107, no. 1–3, pp. 95–106, 2008.
[18]
B. Wampold, The Great Psychotherapy Debate: Models, Methods and Findings, Erlbaum, Mahwah, NJ, USA, 2001.
[19]
B. Wampold, S. Hollon, and C. Hill, “Unresolved questions and future directions in psychotherapy research,” in The Real Relationship in Psychotherapy: The Hidden Foundation of Change, C. J. Gelso, Ed., chapter 11, pp. 333–355, American Psychological Association, Washington, DC, USA, 2011.
[20]
L. Luborsky, L. Diguer, D. A. Seligman et al., “The researcher's own therapy allegiances: a “wild card” in comparisons of treatment efficacy,” Clinical Psychology: Science and Practice, vol. 6, no. 1, pp. 95–106, 1999.
[21]
L. Luborsky, M. Barrett, and D. Antonuccio, “What else materially influences what is represented and published as evidence?” in Evidence-Based Practices in Mental Health: Debate and Dialogue on the Fundamental Questions, J. C. Norcross, L. E. Beutler, and R. F. Levant, Eds., pp. 257–298, American Psychological Association, Washington, DC, USA, 2006.
[22]
F. Leichsenring, “Are psychodynamic and psychoanalytic therapies effective? A review of empirical data,” International Journal of Psychoanalysis, vol. 86, no. 3, pp. 841–868, 2005.
[23]
J. Shedler, “The efficacy of psychodynamic psychotherapy,” American Psychologist, vol. 65, no. 2, pp. 98–109, 2010.
[24]
R. Levy and S. Ablon, Handbook of Evidence-Based Psychodynamic Psychotherapy: Bridging the Gap Between Science and Practice, Humana Press, New York, NY, USA, 2008.
[25]
L. Luborsky, R. Rosenthal, and L. Diguer, “The dodo bird verdict is alive and well-mostly,” Clinical Psychology Science and Practice, vol. 9, no. 1, pp. 2–12, 2002.
[26]
M. Lambert, “The individual therapist's contribution to psychotherapy process and outcome,” Clinical Psychology Review, vol. 9, no. 4, pp. 469–485, 1989.
[27]
A. Horvath and R. Bedi, “The alliance,” in Psychotherapy Relationships That Work: Therapist Contributions and Responsiveness to Patients, J. C. Norcross, Ed., pp. 37–70, Oxford University Press, New York, NY, USA, 2002.
[28]
D.-M. Kim, B. E. Wampold, and D. M. Bolt, “Therapist effects in psychotherapy: a random-effects modeling of the national institute of mental health treatment of depression collaborative research program data,” Psychotherapy Research, vol. 16, no. 2, pp. 161–172, 2006.
[29]
E. Heinonen, O. Lindfors, M. A. Laaksonen, and P. Knekt, “Therapists' professional and personal characteristics as predictors of outcome in short- and long-term psychotherapy,” Journal of Affective Disorders, vol. 138, no. 3, pp. 301–312, 2012.
[30]
D. Biggerstaff and A. R. Thompson, “Interpretative Phenomenological Analysis (IPA): a qualitative methodology of choice in healthcare research,” Qualitative Research in Psychology, vol. 5, no. 3, pp. 214–224, 2008.
[31]
M. Larkin, S. Watts, and E. Clifton, “Giving voice and making sense in interpretative phenomenological analysis,” Qualitative Research in Psychology, vol. 3, no. 2, pp. 102–120, 2006.
