In this article the author challenges the growing view that placebo controls are the sine qua non of psychotherapy efficacy research. The author contends that efforts to transpose to psychotherapy research the definition and the pejorative meanings associated with the medical concept of placebo are inappropriate. Problems that inhere in implementing placebo controls in psychotherapy are described, including the difficulty of ensuring that under nonblind design conditions, therapists and their patients will view both the experimental and placebo treatments as comparably credible. This article also considers six research issues stemming from the definitional requirement that the placebo control for the critical and specific components characteristic of the experimental treatment. Finally, the author proposes the adoption of a research strategy that is more likely than the placebo control model to facilitate the accumulation of knowledge regarding effective elements of psychotherapy.
Policy decisions affecting third-party reimbursements and the continued support of psychotherapy research wjll be based in part on research evidence developed by researchers in the field. This article considers some of the sobering implications of having available research reports interpreted not by sophisticated research-wise investigators but by lay policymakers. The author discusses currently available answers to the policymaker's questions concerning the role of spontaneous remission, the placebo, and the nature of therapist training. He summarizes the reported effectiveness of psychosocial interventions in the treatment of mental disorders, as assessed by the President's Commission on Mental Health. Finally, he offers recommendations for developing mechanisms for providing the decision makers with a scientifically sound data base.
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