Conclusion of Randomized Trials

Randomized trials of psychotherapy effectiveness yield two rather simple conclusions. The first is that there exists a set of problems for which carefully constructed (''protocol'') therapies are effective —according to the criteria that at least one randomized trials study has ''validated'' these forms of psychotherapy. These therapies are listed in a 1995 report from the Task Force on Promotion and Dissemination of Psychological Procedures, division of clinical psychology, American Psychological Association. As the critic Garfield pointed out that same year, these results could not be used as a basis for justifying all—or even most—psychotherapy, or for setting standards. First, the number of conditions and the number of therapies is quite limited, hardly representative of the practice of ''psychotherapy.'' In fact, the task force itself noted that these types of validated therapies are often not even taught in programs that are listed as good ones in various sources for training graduate students in clinical psychology. The constrained nature of the

Standards for Psychotherapy types of therapy provided overlooks, to quote Garfield (pg. 218): "the importance of client and therapist variability, the role of the common factors in psychotherapy, and the need to adapt therapeutic procedures for the problems of the individual client or patient.'' In a highly influential report of a Consumers' Union study he published that same year of 1995, Seligman refers to such studies as ''efficacy'' ones. He writes (pp. 965-966) "In spite of how expensive and time-consuming they are, hundreds of efficacy studies of both psychotherapy and drugs now exist—many of them well done. These studies show, among many other things, that cognitive therapy, interpersonal therapy, and medications all provide moderate relief from unipolar depressive disorder; that exposure and clomipramine both relieve the symptoms of obsessive-compulsive disorder moderately well, but that exposure has more lasting benefits; that cognitive therapy works very well in panic disorders; that systematic de-sensitization relieves specific phobias; that "applied tension'' virtually cures blood and injury phobia, that transcendental meditation relieves anxiety; that aversion therapy produces only marginal improvement with sexual offenders; that disulfram (Antabuse) does not provide lasting relief from alcoholism; that flooding plus medication does better in the treatment of agoraphobia than either alone; and that cognitive therapy provides significant relief of bulimia, outperforming medications alone.'' [See Cognitive Therapy; Psychopharmacology.]

But then Seligman compares such studies to what he terms "effectiveness" studies, that is, those of "how patients fare under the actual conditions of treatment in the field'' (p. 966)— and finally reaches a conclusion with which few of his critics agree: ''The upshot of this is that random assignment, the prettiest of the methodological niceties in efficacy studies, may turn out to be worse than useless for the investigation of the actual treatment of mental illnesses in the field'' (p. 974).

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