The logic of the randomized double-blind placebo control group design is presented, and problems with using the design in psychotherapy are discussed. Placebo effects are estimated by examining clinical trials in medicine and psychotherapy. In medicine, a recent meta-analysis of clinical trials with treatment, placebo, and no treatment arms was conducted (Hróbjartsson & Gøtzsche, 2001), and it was concluded that placebos have small or no effects. A re-analysis of those studies, presented here, shows that when disorders are amenable to placebos and the design is adequate to detect the effects, the placebo effect is robust and approaches the treatment effect. For psychological disorders, particularly depression, it has been shown that pill placebos are nearly as effective as active medications whereas psychotherapies are more effective than psychological placebos. However, it is shown that when properly designed, psychological placebos are as effective as accepted psychotherapies.

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Treatment data from a university counseling center (UCC) that utilized the Outcome Questionnaire-45.2 (OQ-45; M. J. Lambert et al., 2004), a self-report general clinical symptom measure, was compared against treatment efficacy benchmarks from clinical trials of adult major depression that utilized similar measures. Statistical analyses suggested that the treatment effect size estimate obtained at this counseling center with clients whose level of psychological distress was above the OQ-45 clinical cutoff score was similar to treatment efficacy observed in clinical trials. Analyses on OQ-45 items suggested that clients elevated on 3 items indicating problematic substance use resulted in poorer treatment outcomes. In addition, clients who reported their relational status as separated or divorced had poorer outcomes than did those who reported being partnered or married, and clients reporting intimacy issues resulted in greater numbers of sessions. Although differential treatment effect due to training level was found where interns and other trainees had better pre-post outcome than did staff, interpretation of this result requires great caution because clients perceived to have complicated issues are actively reassigned to staff. More effectiveness investigations at UCCs are warranted.

Eleven counseling psychology and counselor education academics were interviewed regarding their experiences of progressing from lower-or lower-middle-class backgrounds to college and, further, to academic positions. Grounded theory method was used for data analysis, and consensual qualitative research methods were used for triangulation and data presentation. Participants described experiences of hardship as children, obstacles to advancement, resources that enabled academic pursuits, and thwarted belonging needs in academic environments and original referent group settings. Bicultural and tricultural identity development were identified as central phenomena for participants. Implications regarding social class as an important aspect of multiculturalism are discussed.

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