Limitations of manualized psychotherapy for everyday clinical practice.

Abstract

Outcome research is important to improving psychotherapeutic procedures. Empirical evaluation of "manualized" clinical procedures, both broad and narrow, is a valuable current research trend. However, the conditions of such research are far removed from the conditions that exist in eveyday clinical practice. The limitations of present data on so-called 'validated treatments" preclude conclusions about what forms of treatment to reimburse or includdexclude in graduate training programs. Future research should emphasize commonly used forms of treatment and more typical patient populations.

The clinical utility of randomized controlled trials

“…One reason for this failure to use empirically supported treatments in general and CBT for BN in particular is that practitioners are skeptical of the relevance of RCTs to clinical practice (Garfield, 1996;Goldfried & Wolfe, 1996;Havik & VandenBos, 1996). An influential expression of this view is Seligman's (1995) recent assertion that ''The efficacy study (RCT) is the wrong method for empirically validating psychotherapy as it is actually done, because it omits too many crucial elements of what is done in the field'' (p. 966).…”

Applying Empirically Supported Treatments to Complex Cases: Ethical, Empirical, and Practical Considerations.

“…Indeed, restrictions in sampling are viewed by some in the field as a grave shortcoming of RCTs, leading them to dismiss ESTs as severely limited for clinical practice and to rely on other means-typically clinical judgment-as the basis for treatment selection and planning (e.g., Fensterheim & Raw, 1996;Havik & VandenBos, 1996;Silberschatz in Persons & Silberschatz, 1998). By contrast, others in the field call attention to many severe cases that are included in RCTs (Stirman, DeRubeis, CritsChristoph, & Brody, 2003) and caution against the assumption that excluded cases are more severe or more clinically representative than included cases (Wilson, 1995).…”

Improving psychotherapeutic services via randomized clinical trials, treatment manuals, and component analysis designs

“…Despite this, there are still the occasional objections that treatment manuals are not appropriate for some forms of therapy (e.g., Bohart, O'Hara, & Leitner, 1998). By far, though, the most common criticism of the treatment manual is that they are too unwieldy for clinical practice, with concerns expressed by some that they can present only general treatment principles, whereas others have argued that they focus too narrowly on techniques without a grounding in general treatment considerations (Havik & VandenBos, 1996;Levant, 1995;Smith, 1995;Strupp & Anderson, 1997).…”