Child and adolescent psychotherapy outcomes in experiments versus clinics: Why the disparity?

Abstract

In a recent article, Weisz, Weiss, and Donenberg (1992) compared the effects of child and adolescent psychotherapy in experimental studies and in studies of clinic practice. Here we update that report with new information and we explore 10 possible reasons why, to date, therapy in experiments appears to have shown larger effect sizes than therapy in clinics. We find that beneficial therapy effects are associated with three factors which are more common in research therapy than in clinic therapy: (a) the use of behavioral (including cognitive-behavioral) methods, (b) reliance on specific, focused therapy methods rather than mixed and eclectic approaches, and (c) provision of structure (e.g., through treatment manuals) and monitoring (e.g., through review of therapy tapes) to foster adherence to treatment plans. These three factors all involve dimensions along which clinic procedures could be altered.

Skills for Social and Academic Success: A School-Based Intervention for Social Anxiety Disorder in Adolescents

“…Positive intervention effects demonstrated by research-based treatments often are not replicated when transported into real-world settings (Weisz, Donenberg, Han, & Weiss, 1995). Although there are no current studies comparing research-based to school-based interventions, a meta-analysis (Weisz, Donenberg, Han, & Kauneckis, 1995) examining treatment implemented in laboratories versus community clinics found that research protocol effect sizes ranged from .71 to .84, compared to effect sizes of −.40 to .29 in clinic settings.…”

Therapist Adherence and Organizational Effects on Change in Youth Behavior Problems One Year After Multisystemic Therapy

“…For example, psychosocial treatments validated in randomized trials are more clearly specified than treatments typically deployed in community mental health settings (see, e.g., Weisz et al 1995a;Weisz et al 1995b). The interplay of (a) organizational characteristics, (b) implementation of empirically supported treatment, and (c) clinical outcomes is largely uncharted territory.…”

School-based mental health services (SBS): A pragmatic view of a program

“…While the results from rigorously controlled, academically administered field trials indicate positive effects of school-based mental health interventions, the effect size dwindles to minimum-to-negative effect size from studies done in pure mental health settings (Weisz et al, 1995) To be continued, SBS must show evidences of a significantly large positive treatment effect to justify the outlays. Without such demonstration, there is no likelihood that this, or other such SBS programs will survive the scrutiny of quality-minded program administrators.…”