Are results of randomized controlled trials useful to psychotherapists?

Two clinicians provided opposite answers to the title question: Persons argued that information from randomized controlled trials (RCTs) is vital to clinicians, and Silberschatz argued that information from RCTs is irrelevant to clinicians. Persons argued that clinicians cannot provide top quality care to their patients without attending to findings of RCTs and that clinicians have an ethical responsibility to inform patients about, recommend, and provide treatments supported by RCTs before informing patients about, recommending, and providing treatments shown to be inferior in RCTs or not evaluated in RCTs. Silberschatz argued that RCTs do not and cannot answer questions that concern practicing clinicians. He advocates alternative research approaches (effectiveness studies, quasi-experimental methods, case-specific research) for studying psychotherapy.

Abuse and disabuse of the drug metaphor in psychotherapy research: hold on to the baby as you throw out the bath.

Stiles and Shapiro (1994) argue that trivial correlations between process variables and treatment outcome point to inherent methodological limitations of correlational designs in process-outcome research. In coming to such a far-reaching (erroneous) conclusion, Stiles and Shapiro are throwing out the baby with the bath. Correlational designs are perfectly appropriate for testing process-outcome correlations if process measures are adequately conceptualized. Examples of case-specific measures of therapist responsiveness are reviewed to illustrate the power of correlational designs.

Measuring the therapist's impact on the patient's therapeutic progress.

This article describes methods and concepts developed by the Mount Zion Psychotherapy Research Group for empirically evaluating the pertinence of suitability of a therapist's interventions (behaviors) to a patient's particular problems, needs, and treatment goals. Intensive studies of 2 brief psychotherapy cases are presented. In these studies, patient-initiated critical incidents (tests) were identified, the case-specific accuracy of the therapist's responses to these incidents was rated, and the impact of these interventions on subsequent patient behavior was measured. The findings indicated that these patients tended to show improvement in the therapeutic process when the therapist's interventions were in accord with their particular problems and treatment goals. The application of this method to clinically relevant studies of psychotherapy is discussed.

An examination of three methods of psychodynamic formulation based on the same videotaped interview.

While psychodynamic theory and therapy are approaching their centennial, the science of psychodynamics is still in an earlier developmental stage. Any scientific field generates the most controversy and excitement when it is still developing. For psychodynamic psychology this means that its basic units of observation as well as its rules for justifying clinical inference in formulating and testing dynamic hypotheses require more development. In short, we are still evaluating different methods for both discovering and validating psychodynamic propositions. This is especially true for central features of dynamic psychology, including intrapsychic conflict, relationships, and transference patterns. This report compares three different methods for making a dynamic case formulation: 1) the Core Conflictual Relationship Theme (CCRT) of Luborsky (Crits-Christoph and Luborsky 1985a,b; Luborsky 1976, 1977, 1984, and companion paper in this issue; Levine and Luborsky 1981), 2) the Plan Diagnosis (PD) method of Silberschatz, Curtis and colleagues of the Mount Zion group (Caston 1986; Curtis and Silberschatz 1986; Rosenberg et al. 1986; Curtis et al. 1988) and, 3) the Idiographic Conflict Formulation (ICF) of Perry and Cooper (1985, 1986, and companion paper in this issue). Each has a slightly different focus. The CCRT focuses on relationship patterns as the central feature of individual dynamics and transference in or out of the treatment situation. The Plan Diagnosis focuses on dynamic features related to transference, resistance and insight in therapy. The Idiographic Conflict Formulation focuses on stress and internal conflict, and the individual's adaptation to them in or out of treatment.

Dependency, self-criticism, and depressive attributional style.

Dependency and self-criticism have been proposed as independent factors in depression. Investigated whether depressive individuals characterized by dependency and self-criticism, respectively, differ with regard to internality of causal attributions for negative events. Sixty psychiatric outpatients completed the Depressive Experiences Questionnaire, the Beck Depression Inventory, the semantic differential, and the Attributional Style Questionnaire. Dependency and self-criticism correlated positively with internality and with each other (p less than .0001). Findings did not support the specificity of dependency and self-criticism as subtypes of depression.

Conceptualizing adult development.

On the premise that human development is a lifelong process, and with awareness of certain limitations of the stage model, the authors conceptualize a new model based on developmental process. This model is offered as a basic model for the development of mental functions and structures in both childhood and adulthood.

A method for establishing reliability of statements from psychodynamic case formulations.

The authors describe a method for assessing the reliability of statements derived from psychodynamic case formulations. By reducing a narrative formulation into a series of distinct statements and rating their relevance to a particular patient, they obtained good interjudge reliabilities.