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This article reports a secondary analysis of past therapy outcome meta-analysis. Fifteen meta-analysis provided effect sizes from 56 studies in previous reviews that met 1 of 3 increasingly stringent levels of criteria for clinical representativeness. The effect sizes were synthesized and compared with results from the original meta-analyses. Effect sizes from more clinically representative studies are the same size at all 3 criteria levels as in past meta-analyses. Almost no studies exist that meet the most stringent level of criteria. Results are interpreted cautiously because of controversy about what criteria best capture the notion of clinical representativeness, because so few experiments have tested therapy in clinical conditions, and because other models for exploring the generalizability of therapy outcome research to clinical conditions might yield different results.

This study used meta-analysis to study the clinical significance of psychotherapy for symptoms of unipolar depression. The following questions were addressed: How similar is the posttherapy adjustment of depressed adults to that of nondcpressed adults? Is this adjustment maintained at followup? What dimensions of treatment, therapists, or design are associated with clinical significance? Using the Beck Depression Inventory (BDI), we calculated composite BDI norms from 28 published studies. Sixty effect sizes (from 31 outcome studies utilizing the BDI} were calculated. The results indicated that psychotherapy produces outcomes that have moderate clinical significance and that are well-maintained at follow-up, that individual therapy is associated with greater clinical significance than group treatment, and that type of therapy is not related to improvement. Alternative approaches for operationalizing clinical significance as the return of individuals to normal levels of functioning are discussed. For many years, studies of the outcome of psychotherapy have concentrated on one basic question: Does a specified treatment produce significantly larger positive effects than do control conditions or other treatments for a particular population? Although methodological refinements, policy considerations, and disagreements about outcomes prompt continued focus on the traditional outcome question, an equally important question has been neglected, namely: Are statistically significant differences between treatment and control subjects also clinically significant? Until clinicians can answer this question in the affirmative, assessment of psychotherapy's effectiveness remains incomplete.Clinical significance can be defined as the extent to which clinical outcomes achieve a meaningful magnitude of change.Currently, empirical literature does not exist that would establish the clinical significance of treatment effects with the same confidence routinely accorded to their statistical significance. However, Kazdin (1982) proposed two approaches for the assessment of clinical significance: (a) subjective evaluation, in which individuals who interact with the client or who are in a position to judge changes in target behavior evaluate whether those changes have led to qualitative differences in how others view the client and (b) social or normative comparison, in which the behavior of clients before and after treatment is compared with the behavior of nondisturbed, normal peers. With this second method, one can define clinical significance by the standard deviation units that separate treated clients from the mean of a normative group (Kendall, 1984).

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