Psychotherapy Research: Current Status and Future Prospects

Abstract

The 2 papers in this In Review section offer complementary perspectives on the field of psychotherapy research. The first article provides an overview of the current state of the field. The second article addresses directions the field should move in the future. Drafts of the 2 articles were prepared independently, with joint involvement occurring only during the revision process. It is noteworthy that each article highlighted 3 issues or themes as being of importance. Further, there are significant parallels in the 3 issues highlighted in each paper. The first article (1) is from the Edmonton Psychotherapy Research and Evaluation Unit at the Department of Psychiatry, University of Alberta. Our intent was to evaluate the status of 3 topics that have been predominant in the field over the past 2 decades. The first is the seemingly perennial question of the effectiveness of psychotherapy as a treatment for emotional problems, defined fairly generally. The technique of metaanalysis has allowed this question to be addressed in a more rigorous, quantitative manner than was possible before 1977. Metaanalytic reviews offer a compelling argument that the effectiveness of psychotherapy has been unequivocally demonstrated. Nonetheless, questions remain about the susceptibility of metaanalysis to bias, such as a particular reviewer's criteria for selecting representative studies to review. The second topic has a more recent history: The empirically supported treatment (EST) movement aims to identify psychotherapy approaches that have demonstrable effectiveness in the treatment of specific mental disorders. Studies providing the evidence for ESTs use randomized clinical trial designs and carefully select patients meeting diagnostic criteria for one or more specific disorders. Thus the studies are more focused than the psychotherapy studies included in most metaanalytic reviews. The EST movement has had considerable impact on clinical training and practice, particularly in the United States, and this has not been without controversy. We consider both the value and the limitations of the EST perspective. The third topic also has a long history in the field. In contrast to effectiveness studies or research to demonstrate an EST, the perspective focuses on possible therapeutic elements of psychotherapy that cut across orientations or interventions. That is, rather than searching for differences in effectiveness between treatments for the general class of emotional problems or specific disorders, common factors research emphasizes identifying the necessary factors associated with change in psychotherapy of whatever stripe. Common factors research thus tends to be more integrative (clumping rather than splitting) and has generated a considerable literature on important curative factors in the psychotherapeutic process. Unfortunately, most of these findings are based on correlational designs and thus offer little in terms of specifying causal mechanisms of change. A theme runs through our overview of these 3 topic areas. Although the field has definitely advanced-in terms of demonstrating the effectiveness of psychotherapy, identifying empirically supported therapies, and developing models of the essential factors involved in therapeutic change-critical deficiencies can be identified in each area. A complete understanding of how psychotherapy can actually bring about remediation and rehabilitation continues to remain, at best, only partially formulated. The second paper (2) describes a promising direction worth developing to deal with these stubborn critical deficiencies in our research approaches. We were fortunate to have Dr Karla Moras agree to serve as the author of this paper. Briefly, Dr Moras contends that needed advancements in psychotherapy research can now be accelerated by incorporating the findings and methods of contemporary neuroscience into our investigations. Dr Moras is a respected authority in the field, given her career affiliations with outstanding researchers (for example, graduate training with the late Hans Strupp at Vanderbilt University; a postdoctoral fellowship at the National Institute of Mental Health, with mentoring by Irene Elkin and Myrna Weissman; and a faculty involvement for 12 years with the Center for Psychotherapy Research at the University of Pennsylvania). …