Science as an ally of practice.

Abstract

Well-founded criticisms of the Consumer Reports (CR; 1995) study of psychotherapy include possible bias of the CR sample; limitations of self-report; and the limitations of cross-sectional, retrospective data. Poorly founded criticisms concern "consumer satisfaction" and the claim that the remarkably good effects of long-term therapy resulted from spontaneous remission, that psychotherapy effects were small, and that nondoctoral providers did as well as doctoral-level providers. Both the experimental method (efficacy) and the observational method with causal modeling (effectiveness) answer complementary questions, and they both do so by eliminating alternative possible causes. Efficacy studies, however, cannot test long-term psychotherapy because long-term manuals cannot be written and patients cannot be randomized into two-year-long placebo controls, so the "empirical validation" of long-term therapy will likely come from effectiveness studies. Such studies of long-term therapy, of qualifications of providers, and of clinical judgment versus case management are urgently needed as practice confronts managed care.