NIMH Treatment of Depression Collaborative Research Program. Background and research plan.

The National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program (TDCRP) is the first multisite coordinated study initiated by the NIMH in the field of psychotherapy research. Three research sites, using an identical research protocol, are investigating the effectiveness of two forms of brief psychotherapy (cognitive behavior therapy and interpersonal psychotherapy) in the treatment of outpatient depression. Three training sites have trained experienced therapists in a standard fashion for each of the psychotherapies and the comparison pharmacotherapy conditions. This report presents the background of the TDCRP, the rationale for the choice of patient population and treatment conditions, and the research plan for both the training/pilot phase and the outcome study currently in progress, and discusses the potential contributions of the program to the field of psychotherapy research.

Psychotherapy research evidence and reimbursement decisions: Bambi meets Godzilla.

Research evidence on psychotherapy outcome is both extensive and positive. However, the evidence is not responsive to the question. What kinds of psychotherapy are most effective for what kinds of problems? It is demonstrably feasible to conduct scientifically meritorious studies of process and outcome; however, the prospect that rigorous research evidence will soon provide a credible list of "certified" psychotherapy techniques and procedures for the treatment of specific disorders is poor. The author presents recommendations for what the doctor can do for the policy maker "until the researcher comes."

Psychotherapy and research: an anaclitic depression. The Twenty-third Annual Frieda Fromm-Reichmann Memorial Lecture.

The twin fields of psychotherapy and psychotherapy research have emerged, developed, and flourished in essentially untrammeled independence of each other. They have grown along parallel lines, and, like well-mannered parallel lines, they have only rarely touched. It may appear self-evident that each field could be advanced by active cooperation and reciprocal use of the findings and insights of the other. And so it might, were it not for the empirically demonstrated truth that the separate interests of each have been equally or better served by the tacit agreement not to intrude seriously on each other's territory or claims. We researchers have, for the most part, overlooked much of psychotherapy as actually practiced because it is difficult to study; instead we have elected to investigate those forms which albeit less widely practiced are more accessible to research. In turn, we psychotherapists appear to have ignored much of the available research findings. As a consequence, the efforts of the practitioner-theorist have provided but little stimulus to the researcher, and the researcher had had but little impact on the mainstream of psychotherapies. The therapist and researcher appear, too, to have other reasons for maintaining a seeming aloofness. While both are avowed seekers after the truth--or truths--each has selected different belief systems to serve as prosthetic devices for the mind in achieving their common goals of certitude. The therapist holds to the view that psychotherapy is and must remain primarily an art form, while the resercher believes that psychotherapy is but a quasi-art form and must become a science, or at least a quasi-science. The resultant differences in the values of the protagonists are frequenty characterized or caricatured by highlighting differences in the emphases placed by scientists and artists on such counterposed concepts as: reality vs. symbols, determinism vs. freedom, events vs. meanings, logic vs. intuition, and quantification vs. comprehension. The psychotherapits finds compelling the authority of revealed theory--theory which is confirmed regularly by personal experience with one's patients. Such experiential learning is also reinforced by like-minded colleagues and supervisors. The psychotherapists' enduring devotion to a preferred theory appears to confirm the observation of William Hazlitt, who said, "A favorite theory is a possession for life." The researcher, on the other hand, finds compelling the authority of rigorously controlled, logically designed, replicable studies which are intended to place even a favorite hypothesis in dire jeopardy. To the scientist, not the least of the charms of a theory is the possibility that it may be refutable. The scientist seems to find comfort in maintaining an attitude of doubt and skepticism--an attitude frequently mistaken for evidence of scientific rectitude...