Critical dimensions in the choice and maintenance of successful treatments: Strength, integrity, and effectiveness.

Abstract

Successful clinical practice demands that we use good judgment in choosing optimal treatments for the conditions in question. However, the criteria on which we base our choice are often implicit. In this article, it is argued that practicing clinicians can enhance the quality of these judgments by attending more explicitly to the strength and integrity of treatment as well as to specific standards of treatment effectiveness. Numerous examples from the psychological and evaluation literature are utilized to portray the practical considerations and problems inherent to this approach. By monitoring strength, integrity, and effectiveness for the duration of treatment, we can make appropriate mid-course corrections and determine the relationship among these three critical dimensions of treatment.Many of the issues confronted by research scientists are also likely to be quite relevant to professionals who evaluate and treat personal problems. We have recently written several papers that deal with issues of special interest to evaluation researchers in the fields of health and psychology. The concepts in these papers are not field-specific and appear to us to be quite pertinent to practicing clinicians as well. Our major purpose in the present article, then, is to suggest alternative perspectives on and procedures for clinical research and practice that may be particularly useful to clinicians. Testing these procedures in the proving grounds of clinical practice may in turn generate other new concepts of interest to research scientists. Issues Regarding the Choice and Maintenance of Successful TreatmentsThere is a seemingly infinite number of aspects of the patient-problem nexus that will potentially influence the choice of treatments for clinical problems. However, our emphasis will instead be directed to impor-Requests for reprints should be sent to

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