Toward a working through of some core conflicts in psychotherapy research

Center for Psychotherapy Research, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104-3309, USA.
Psychotherapy Research (Impact Factor: 1.75). 02/2009; 19(1):1-12. DOI: 10.1080/10503300802609680
Source: PubMed


The author discusses the evidence for six basic statements that many, but not all, psychotherapy researchers adhere to: (1) The therapeutic alliance has a causal role in outcome, (2) therapeutic techniques explain patients' outcome, (3) therapists determine outcome, (4) patients determine therapy outcome, (5) randomized controlled trials (RCTs) provide valuable data, (6) data from RCTs are almost worthless. These "truths" combine to form three core conflicts: Is psychotherapy about the alliance or techniques? Does the patient or therapist determine the outcome? Are RCTs a blessing or a curse? After showing that these statements oversimplify the research of the therapeutic process, the author recommends keeping both sides of the conflict in awareness and endorses a pluralistic methodological approach for the study of both efficacy and the mechanisms of psychotherapy.
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    • "Another reason for challenging the assumption that therapists' reported alliance predicts outcome is the possibility of reverse causation. Some researchers have argued that the quality of the alliance may be the result of preceding symptomatic change, and that it is early symptomatic improvement that accounts for the alliance-outcome association (e.g., Barber, 2009; DeRubeis, Brotman , & Gibbons, 2005; DeRubeis & Feeley, 1990). Several studies have examined the temporal relationship between patient-reported alliance and outcome (Falkenström et al., 2013; Zilcha-Mano, Dinger, McCarthy, & Barber, 2014; Zilcha-Mano & Errázuriz, in press), but almost nothing is known about the temporal relationship between therapist-reported alliance and outcome. "
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    ABSTRACT: Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists' contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at 1 time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient's perspective on the alliance. Taken together, the findings attest to the importance of improving therapists' ability to detect deterioration in the alliance. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Journal of Counseling Psychology 08/2015; DOI:10.1037/cou0000106 · 3.23 Impact Factor
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    • "Thus, process-outcome research is needed to determine the active ingredients. While some progress has been made, this remains a priority for CBT researchers, as it is also for psychotherapy researchers of all stripes (Barber, 2009). Better understanding the mechanisms at play in CBT will help better understand how to further enhance CBT treatments in several regards . "
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    ABSTRACT: Cognitive behavior therapy (CBT) has come to be a widely practiced psychotherapy throughout the world. The present article reviews theory, history, and evidence for CBT. It is meant as an effort to summarize the forms and scope of CBT to date for the uninitiated. Elements of CBT such as cognitive therapy, behavior therapy, and so-called "third wave" CBT, such as dialectical behavior therapy (DBT) and acceptance and commitment therapy (ACT) are covered. The evidence for the efficacy of CBT for various disorders is reviewed, including depression, anxiety disorders, personality disorders, eating disorders, substance abuse, schizophrenia, chronic pain, insomnia, and child/adolescent disorders. The relative efficacy of medication and CBT, or their combination, is also briefly considered. Future directions for research and treatment development are proposed.
    Psychodynamic Psychiatry 08/2015; 43(3):423-461. DOI:10.1521/pdps.2015.43.3.423
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    • "The alternative to randomization is the real world design in which patients select their own treatment. The major advantage of self-selection over a randomized design is generalizability (Barber, 2009; Leichsenring, 2004; Sandell, 2001, Westen et al., 2004), which is to say that this design more closely approximates what is generally done in clinical practice, where patient preference plays a significant role in treatment selection. Those advocating for a patient preference design raised the reasonable concern that patients willing to be randomized in a research study may not be representative of patients treated in clinical practice, although there are no data to support or refute this. "
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    ABSTRACT: In this article, we describe the development of the Comparative Outcomes in Psychotherapy and Psychoanalysis Study (COPPS). COPPS is planned to be a multisite outcome and process study of psychoanalysis that incorporates methodology that is now standard for clinical trials and particularly psychotherapy studies. We begin with an overview of the process of protocol development and key methodological issues. Next, we describe a completed pilot study that establishes the feasibility of randomizing patients to analysis. We then discuss what is needed to execute the study and the potential impact on and value for the field.
    Psychoanalytic Inquiry 01/2015; 35(sup1):150-168. DOI:10.1080/07351690.2015.987601 · 0.47 Impact Factor
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