Psychotherapy Outcome Research Research Articles

Projective Testing as a Heuristic “Snapshot” of Themes in Child and Adult Psychoanalysis The Case of Lisa

This article is an attempt to link images and themes from the Children's Apperception Test protocol of a child at age eight to the vicissitudes of her analytic treatment as both a child and an adult. Striking consistencies were found between the object representational paradigms depicted in the test protocol and both later interpersonal interactions of the patient in her world and key transferential enactments within her treatments as a child and an adult. Lapses in inner coherence in the face of strong affect typify both her protocol and her experience of treatment and later life. These consistencies raise interesting questions regarding the nature of change over time in treatment. They speak to the manner in which adaptive change can occur while core representational paradigms retain earlier, less adaptive flavorings. It is argued that projective test data, with its capacity to speak to the phenomenology of actual experience, should be relied on as a useful tool in psychotherapy outcome research.

Depression in Context: Strategies for Guided Action

Back to table of contents Previous article Next article Book Forum: Mood DisordersFull AccessDepression in Context: Strategies for Guided ActionJOHN C. MARKOWITZ, M.D., JOHN C. MARKOWITZSearch for more papers by this author, M.D., New York, N.Y.Published Online:1 Jul 2003https://doi.org/10.1176/appi.ajp.160.7.1366AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This book on depression is draped in crepe, yet optimistic. It opens with acknowledgments by the coauthors and widow of the late Neil Jacobson, whose death was a great blow to behaviorism and to psychotherapy research. His collaborators on an important study of behavioral activation, an antidepressant treatment, have written this testament to his ongoing work. It is a labor of love and an impressive document.Although behavior therapy has a long history and data support its use for depression, the strategy of increasing pleasurable activities and decreasing unpleasurable ones has struck many therapists as simplistic. Over decades, especially in the United States, behavioral therapy withered as an independent modality and was incorporated into cognitive behavior therapy, which uses behaviors mainly to test the validity of underlying automatic, irrational thoughts. That is, behaviors were subordinated to cognitions. In 1996, however, Jacobson and colleagues (1) dismantled cognitive behavior therapy in a randomized, controlled three-cell trial of 150 patients with DSM-III-R major depression. They found that behavioral activation, a purely behavioral intervention, worked as efficaciously as full cognitive behavior therapy—without addressing negative cognitions. A study is now comparing behavioral activation, cognitive behavior therapy, paroxetine, and placebo (S. Hollon, personal communication, Jan. 2003).This book is a behavioral activation manual. It is coherent, serviceably written (although it wants proofreading), and clinically useful. It provides therapeutic prescriptions, proscriptions, contingencies for difficult patients, and case examples, while omitting a few points such as the length of the treatment (possibly 20 sessions). Because few psychiatrists have received good behavioral training, they should benefit from reading and using this book.Readers may struggle with the behavioral activation focus on the patient’s behavior rather than on inner intention or feeling. The authors contrast behavioral activation to the inward-focused cognitive, psychodynamic, and biological explanations of depression. By counterintuitively minimizing attention to feelings and thinking, behavioral activation offers a very different view of depression—as a narrow repertoire of passive, avoidant behaviors responding to deprivation and conditioned by negative reinforcement. “Behavior matters” (p. 106): depression disrupts activities and comfortable daily routines. Behavioral activation “activates” patients to broaden their behavioral repertoires in handling the environment, increasing positive reinforcement and mastery through graded task assignments. The authors thus resurrect behavioral therapy as an “antimentalistic,” externally oriented therapy of environmental “context” focusing on the relationship of depression to external situations (e.g., losing a job) rather than on the intrapsychic. They present this as a “radical” idea (p. 16).This raises two points. One concerns the insularity and parochialism of psychotherapies: one school often does not know another. These behaviorist authors mainly compare behavioral activation with cognitive therapy and, more distantly, psychodynamic and biological approaches. They seem unsure of the latter and blind to the overlap of their environmental outlook with interpersonal psychotherapy (2), an antidepressant approach since the 1970s that stems from a more-than-50-year tradition (3). Like interpersonal psychotherapy, behavioral activation is “pragmatic” (p. 40) and problem-solving (p. 126), debriefs patients’ weekly activities (p. 55), links mood to life situation, explores options (p. 123), coaches testing effective responses to the environment, uses role playing (p. 114), and serially assesses symptoms (p. 108). The two treatments differ considerably, but the interpersonal psychotherapy manual receives only one passing mention (p. 7), and interpersonal psychotherapy and behavioral activation never receive the close comparison they deserve. Nor do the authors acknowledge “CBASP” (cognitive behavior analysis system of psychotherapy), a more eclectic but heavily behavioral treatment for chronic depression (4).The second point concerns dismantling designs. The 1996 report comparing cognitive behavior therapy and behavioral activation leads readers to imagine that behavioral activation is simply the stripped down behavioral component of cognitive behavior therapy. As this book clarifies, however, the researchers perforce developed a treatment with a separate outlook, rationale, and theory. Since, as the authors reiterate, behavioral activation is not standard old behaviorism, it is not merely the “B” in “CBT.” Indeed, they have developed a behaviorism that seems to overlap with a rival psychotherapy, interpersonal psychotherapy. Dismantling psychotherapies to test the efficacy of their component ingredients is an important aspect of psychotherapy outcome research, but a complicated and easily confounded one.By Christopher R. Martell, Ph.D., Michael E. Addis, Ph.D., and Neil S. Jacobson, Ph.D. New York, WW Norton & Co., 2001, 223 pp., $32.00.

Empirically Documenting Clinically Significant Change in Rational Emotive Behavior Therapy

The purpose of the present article is to outline the conceptual foundation and practical methodology of the Jacobson-Truax Clinically Significant Change index, derived from psychotherapy outcome research. This way of considering what constitutes clinically significant change in psychotherapy puts a premium on social validation. It empowers clinicians to evaluate the meaningfulness of their client's progress and to communicate that progress to third parties such as other clinicians, researchers, and insurers. Application of the method is demonstrated in the case of a client treated with Rational Emotive Behavior Therapy (REBT). The discussion focuses on the advantages of this procedure for satisfying the intellectual interest of the practitioner-scientist and for furthering informed discussion of the value in various applications of REBT to clinical problems.

Leading researchers' consensus on psychotherapy research findings: Implications for the teaching and conduct of psychotherapy.

We examined leading international psychotherapy researchers’ views on psychotherapy outcome research. Participants completed a questionnaire on which they rated level of research evidence for or against various assertions about psychotherapy processes and outcomes. Participants rated how confident they were that the assertions were supported by psychotherapy research. Strong, or relatively strong, consensus was achieved on several of the questionnaire items. Areas for which relative uniformity of opinion does or does not exist have potential implications for the teaching and conduct of psychotherapy and for the science–practice interface in psychotherapy. Additionally, consensus about psychotherapy findings can be used as a yardstick by which to measure practicing clinicians’ knowledge of the research. In 1949 at the Boulder Conference, the profession of clinical psychology declared its allegiance to the goal of integrating science and practice and cast the field in the “scientist–practitioner model,” or the Boulder Model (Raimy, 1950). Additionally, at the Vail Conference in 1973, the profession of clinical psychology addressed the science–practice interface but endorsed a “professional model” of training focused on practitioner training issues and psychologists as consumers and users of research (Korman, 1974). Both the Boulder and Vail Conferences emphasized the knowledge and use of psychological research in clinical practice. A central mission of the profession of psychology was to accumulate scientific knowledge in order to advance the understanding

Normative data on cognitive measures of depression.

The assessment of cognition and cognitive change is important for case conceptualization, monitoring the efficacy of specific interventions, and evaluating treatment outcome in cognitive-behavioral therapy. Unfortunately, a paucity of normative data exists on cognitive measures used for psychotherapy outcome research in depression, and little information is available to guide a practitioner's understanding of the magnitude and clinical significance of a patient's cognitive change. This article presents normative data on 6 self-report instruments that assess negative and positive automatic thoughts, hopelessness, cognitive biases and errors, and dysfunctional attitudes. Normative data were derived from studies published from the date of inception of a given cognitive index to the year 2000. Recommendations for the use of these normative data are provided.

OPTIMAL AND NORMAL AFFECT BALANCE IN PSYCHOTHERAPY OF MAJOR DEPRESSION: EVALUATION OF THE BALANCED STATES OF MIND MODEL

The reformulated balanced states of mind (BSOM) model (Schwartz, 1997) proposed new cognitive-affective set-point ratios based on a mathematical model of consciousness (Lefebvre, 1990) to differentiate among pathological, normal and optimal balances. Using data derived from the Affects Balance Scale (Derogatis, 1975), the reformulated set-points were empirically evaluated by tracking changes in affect balance SOM (ratio of positive to total affect) in 66 depressed male outpatients undergoing cognitive-behavior therapy (n = 45) or pharmacotherapy (n = 21). Confidence interval estimations indicated that across treatments both remitted (SOM = .35) and unremitted (SOM = .35) patients had pathological pretreatment affect balances near the predicted set-point (.38). At post-treatment, affect balance for remitted patients (SOM = .74) progressed to a normal dialogue near the predicted set-point (.72), whereas unremitted patients maintained a negative balance (SOM = .41). Using Hamilton and Global Assessment Scale ratings, remitted patients were classified into average and optimal responders. At post-treatment, average responders achieved an affect balance (SOM = .70) near the normal dialogue set-point (.72), whereas optimal responders progressed to an affect balance (SOM = .81) at the optimal dialogue set-point (.81), supporting the theoretical distinction between normal and optimal balance. A mathematically generated measure that distinguishes normality and optimality permits increased quantitative precision in comparative psychotherapy outcome research.

Reflecting on homework in psychotherapy: what can we conclude from research and experience?

This article examines the empirical basis of using homework in psychotherapy and then offers a synthesis of the research literature with the preceding clinical articles. We provide a practitioner-friendly review of psychotherapy process and outcome research literature, concluding that there is now sufficient evidence to support the assertion that homework assignments enhance psychotherapy outcomes. It is also clear that homework compliance is a consistently significant predictor of treatment outcome. Limitations of existing studies and future research directions are outlined, and we suggest that more specific questions are required regarding the integration of homework into therapy process. Clinical recommendations and issues in homework administration described in preceding articles are also synthesized. The research evidence and contributors to this issue converge in recommending homework within the broad context of psychotherapy and using creative ways of administering homework that is customized to the client.

Odysseys in Psychotherapy

Back to table of contents Previous article Next article Book Forum: PsychotherapiesFull AccessOdysseys in PsychotherapyJOHN C. MARKOWITZ, M.D., JOHN C. MARKOWITZSearch for more papers by this author, M.D., New York, N.Y.Published Online:1 Mar 2002https://doi.org/10.1176/appi.ajp.159.3.508-aAboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The editors begin inauspiciously by asking, “Is psychotherapy a science or is it poetry? Is this even a meaningful question to ask?” Such musing led them to ask “luminaries of psychotherapy” to recount their careers and what they “believe” about psychotherapy (p. ix). The authors then wonder, “If an asteroid were arriving…soon to shatter our planet…[with] loss of most human life and recorded thought” (p. 1), which psychotherapy books would we wish to survive? Such overheated, jejune writing risks having the reader stop before reaching the psychotherapists’ autobiographies that follow.The editors’ premise is that the lives of “a wide range” (p. 8) of prominent psychotherapists should illuminate the field. Even conceding the value of the wisdom of exemplars, one questions the editors’ method. They claim to have recruited “stellar and internationally renowned therapists” of “the second half of the 20th century” (p. 7), but their selection is skewed. Most of the 16 alphabetically presented participants (nine men, six psychiatrists, six psychoanalysts, mainly Boston-connected, and one apparently the father of one of the editors) have decidedly psychodynamic backgrounds. Are they luminaries? I recognized about half the names. None is an empiricist, and most mention psychotherapy outcome research only naively and dismissively. Aaron Beck, presumably an important innovator, does not even make the index; nor do many others. Most cited, after authorial self-reference, is Freud. The reader never learns the rationale for selection, or how many therapists were approached but declined to participate.Not all psychotherapists make superb memoirists. The writing is sometimes self-indulgent, self-important, and self-promoting. Some writers have led interesting lives, but most list events or define theory rather than describe their emotions in depth. Boston training programs evidently once taught elitist, paternalistic, misogynistic, rigidly intrapsychic psychodynamic theory, against which many of these writers rebelled. Their accounts reflect this with a vengeance: many have utterly abandoned an internal perspective, from which we might have learned the determinants of their decisions, to focus instead on externalities.There are exceptions, such as the rousingly opinionated septuagenarian Sophie Freud’s ambivalently agnostic attitude toward her grandfather. Maltsberger, Pines, and A. Wheelis recount moving histories; Wachtel argues well. But the most surprising aspect of this book is the impersonality of most therapists’ self-disclosure. Their opacity obscures how their lives explain their therapeutic direction. We learn that they changed, but not why—a singularly unsatisfactory result. Perhaps focused interviews—a more psychotherapeutic format—would have yielded greater introspection and information.Some therapists, rejecting the old faith, converted to new ideologies: ethnocultural psychology, lesbian feminist psychiatry, social constructionism, relational psychology, and even psychoanalytic parapsychology! As nonempiricist clinicians, they can offer only opinions and exhortations to support their approaches, resulting in what A. Wheelis calls a “chorus of contending voices” (p. 402) of seemingly equal valence. As a helpful guide to the future, this serves only as a cautionary example.The volume’s late-20th-century time frame coincides with the collapse of long-term psychoanalytic hegemony. Most authors unsurprisingly seem to have moved from longer to briefer treatments and from an intrapsychic, theoretical focus to a more experiential, “responsive, connected relationship” (p. 77) with patients. They responded to the social unrest and liberation groups of the 1960s and 1970s. One acknowledges, “My coming of age…paralleled changes in the mental health field” (p. 84). Rather than highlighting individual differences, the book leaves an impression of secular change and reads best as an informal history of the already fading, pre-empirical, pre-managed-care era. Although the editors hope to provide “clues to the future” (p. 403), the psychotherapeutic prognostications are unhelpful, banal, or curious, auguring deterioration of therapeutic expertise under managed care or emergence of the “therapist-shaman-psychopharmacologist-psychotechnologist” (p. 62). The book is more oddity than odyssey.Edited by Joseph J. Shay and Joan Wheelis. New York, Irvington/Ardent Media, 2000, 428 pp., $44.95. FiguresReferencesCited byDetailsCited ByNone Volume 159Issue 3 March 2002Pages 508-a-509 Metrics History Published online 1 March 2002 Published in print 1 March 2002

Assessing clinical significance: Application to the beck depression inventory

Traditionally, psychotherapy outcome research has been analyzed using statistical tests of significance. Inherent limitations in this approach, however, have contributed to the assessment of clinical significance being advocated as a method by which to evaluate change. In this study, Tingey, et al, 1996a , Tingey, et al, 1996b extensions and clarifications of Jacobson, Follette, and Revenstorf's (1984) method for evaluating clinically significant change were applied to the Beck Depression Inventory (BDI; Beck, Ward, Mendelson, Mock, & Erbaugh, 1961 ; Beck, Rush, Shaw, & Emery, 1979 ). A three-sample normative continuum (asymptomatic community, community, and clinically symptomatic) was formulated from the community and the existing literature. The distinctness of the normative samples was assessed by using three statistical procedures, including a t test, a d test, and a test of bioequivalence; and reliable change indices and cutoff points were calculated. The cutoff scores that were developed may prove useful in research and clinical practice.

An administratively created reality: Some problems with the use of self‐report questionnaire measures of adjustment in counselling/psychotherapy outcome research

Outcome research in counselling and psychotherapy has come to rely heavily on the use of self‐report questionnaire measures of anxiety, depression and general symptomatology. The validity of these measures in the context of psychotherapy research has, in general, been taken for granted. This paper proposes that, despite the success of self‐report questionnaires in personality research and personnel selection, there are significant problems involved in the use of these methods in research into therapeutic change. Specifically, three areas of difficulty are reviewed. First, questionnaires are completed in a social setting that itself changes as a result of therapy. Second, the experience of psychotherapy changes the way that clients make sense of questionnaire items (the ‘response shift’ phenomenon). Third, the conceptualisation of the person implicit in questionnaire design is not compatible with the conceptualisation of persons espoused by most contemporary therapeutic approaches. It is argued that the continuing popularity of self‐report questionnaires can be understood in terms of Kurt Danziger's model of the social construction of psychological knowledge.

Rewriting the agenda for training in clinical and counselling psychology

This paper describes a model for future training in clinical and counselling psychology. The model is based on the results of psychotherapy outcome research, and the development of empirically supported therapies, as well as recent developments in the use of information technology in psychotherapeutic interventions. It is also argued that developments such as the increasing cost of mental health interventions, the wide disparities in access to specialised mental health assistance, and the rise of the mental health consumer movement all provide a context for recommendations as to optimum developments in training for clinical and counselling psychologists.

Psychometric properties of goal-attainment scaling in the assessment of mann's time-limited psychotherapy.

This study tested the reliability and validity of Goal-Attainment Scaling (GAS) in assessing outcome in Mann's Time-Limited Psychotherapy (TLP). Judges constructed GAS scales for 33 patients on five dimensions: severity of symptoms, self-esteem, same-sex friendships, romantic relationships, and work performance. Patients in the treatment group received 12 sessions of TLP, whereas controls were in a waiting list for the same period of time (12 weeks) before starting time-limited psychotherapy. Judges rated all patients on GAS before beginning therapy, at termination, and follow-up. Mean interrater reliability of scores between pairs of judges was r = .88. Convergent validity of the GAS was confirmed by moderate to high correlations with the Health-Sickness Rating Scale (r = .70, p < .001), the Target Complaints Scale (r = .50, p <.01), and the Brief Symptom Inventory (r = .38, p < .05). The findings are discussed and recommendations are made for the reliable and valid use of the GAS in psychotherapy outcome research.

Is Brief Better? A Modified Brief Solution-Focused Therapy Approach for Adults with a Developmental Delay

Although the clinical literature reports that psychotherapists have increasingly used brief solution-focussed therapy with a variety of populations, there is no mention of the use of this model with adults who have a developmental delay. This descriptive paper discusses a modified brief solution focussed approach with clients at Surrey Place Centre and the authors' initial attempts to evaluate it. We found that our modified approach was most successful for those who were higher functioning, were self-referred, and were supported in the therapeutic process by others. Those clients with fewer presenting problems and whose problems were related to self-esteem, family, and loss also fared better overall, according to clinician ratings. Our brief therapy service was delivered in less time (mean 118 days) than service to our clients in long-term psychotherapy (mean 372 days) (p < .001), with less of a waiting period for service. Clients and their caregivers were satisfied with the service as reported in a six-month follow-up questionnaire when compared with both norms for the satisfaction measure used and with the responses of our clients in long-term psychotherapy. Our experience suggests that this modified approach should continue to be used with some of our clients. Advantages and disadvantages of the model are summarized. The need for more sophisticated psychotherapy outcome research is emphasized given the unique needs of this population.

Future Directions in Adventure-Based Therapy Research: Methodological Considerations and Design Suggestions

The need for more methodologically sound research in adventure therapy (AT) is commonly discussed among AT professionals. Clearly, as the culture of the psychological community is increasingly influenced by both managed care and the movement toward empirically-validated treatments, the need for solid research in AT is becoming progressively more urgent. This article focuses on summarizing some of the necessary considerations for conducting outcome studies in AT from the perspective of psychotherapy outcome research. Specific suggestions for future design strategies that can be implemented in AT settings will also be discussed.

Determining the pertinence of psychotherapy outcome research findings for clinical practice: Comment on Westen and Morrison (2001).

D. Westen and K. Morrison's (2001) article is a challenge to advocates of empirically supported therapies (ESTs) and to the research enterprise that has determined which therapies are given the EST designation. Their concern that the long-term effects of ESTs are understudied and, apparently, weak is valid. However, their pessimistic conclusions about the generalizability of the results from outcome studies of ESTs are based on a serious logical error. The authors of the present article described an alternative research method that can address important and appropriate questions about the generalizability of ESTs. Continued dialogue between proponents and opponents of contemporary trends in psychotherapy outcome research is encouraged.

A brief, multidimensional, problem-solving psychotherapy outcome measure.

This article provides a test of an application of M. Zeidner and D. Saklofske's (1996) adaptive model of coping to counseling through the development of a brief multidimensional outcome measure for psychotherapy that specifically examines clients' resolution of their presenting problems. Exploratory and confirmatory factor analyses revealed 4 primary factors, all reflecting different components of clients' problem resolution: (a) Problem-Solving Strategies, (b) Problem-Solving Self-Efficacy, (c) Problem Impact on Daily Functioning, and (d) General Satisfaction With Therapy. Descriptive statistics, normative information, and reliability and validity estimates suggest that the Problem Resolution Outcome Survey has promise as an effective psychotherapy outcome measure. The results support the application of Zeidner and Saklofske's adaptive model of coping to the therapy process, as well as the utility of problem-solvi ng constructs within psychotherapy outcome research. In 1965, Krumboltz maintained that the central reason for the early existence of the applied counseling and clinical professions was that clients need professional assistance for troublesome problems they have not been able to resolve on their own. Sixteen years later, in defining counseling psychology, Fretz (1982) reiterated that counseling aims to increase clients' ability to solve problems and make decisions. In essence, problem solving has been repeatedly conceptualized as central to psychotherapy for decades (e.g., D'Zurilla & Goldfried, 1971; Heppner, 1978; Horan, 1979; Urban & Ford, 1971). Regardless of theoretical orientation, the common goal and thus outcome of psychotherapy can be conceptualized as helping clients to more effectively resolve their concerns or problems (e.g., Heppner & Krauskopf, 1987).

The evolution of clinical significance.

During the evolution of the concept of clinical significance, there has been a continuing dialog about and refinement of the construct. In this issue Sheldrick, Kendall, and Heimberg apply Kendall, Marrs-Carcia, and Sheldrick's method of equivalency testing and normative comparisons to treatments for conduct disorders. This method has important advantages over traditional meta-analytic approaches. However, analyzing results at the level of group means rather than the individual level loses significant information and can be misleading. Problems in reporting practices and inadequate attention to measurement issues continue to make efforts to assess the clinical importance of studies difficult. We renew a call for the assessment of clinical significance at the individual level of analysis, suggesting it is necessary to guide to selection of empirical supported treatments and in advancing theoretically driven programs of psychotherapy outcome research.

The Future of Psychotherapy Outcome Research: Science or Political Rhetoric?

Although the relationship between research and clinical psychology has at times been conflicted, it has also been productive. Psychologists from both specialties have benefited from each others' work. The area of psychotherapy outcome research represents an important interface between the fields of clinical and research psychology. In an era of scarce resources and demands for accountability, there is pressure for researchers to justify the value of clinical practices. Recently, numerous articles have appeared recommending changes to the way psychotherapy research is conducted. The authors of these articles emphasize with urgency the importance of conducting and reporting research in a manner that will influence the decisions of policymakers and sanction funding for psychotherapy services. This article is an exploration of the impact of these recommendations, whose objective appears to be the promotion of psychological techniques for inclusion in clinical practice guidelines. It is argued that such recommendations may be in conflict with the philosophy and methods of science and may adversely affect public perception, perhaps leading psychologists to be seen as political lobbyists rather than clinicians and researchers.

Enhancing the clinical relevance of psychotherapy outcome research

Despite the many studies of psychotherapy outcome, generalisation of the results of these studies to clinical practice is difficult. Psychotherapy outcome research needs to become more clinically relevant. Patients who are recruited to psychotherapy studies need to be more clinically representative of patients seen in a naturalistic setting, as opposed to belonging to a specific diagnostic group.

Cognitive Therapy and Empirically Validated Treatments

Most historiographers of psychotherapy point to Eysenck's (1952) formative critique of the field as a significant rallying call to psychotherapy researchers and practitioners to demonstrate the effectiveness of psychotherapy over and above various estimates of natural recovery or so-called spontaneous remission (Bergin & Garfield, 1994; Nathan & Gorman, 1998; Roth & Fonagy, 1996). Although the data and methods employed by Eysenck were brought into question by several researchers (cf. Bergin, 1971), the debate over Eysenck's claims has persisted over the years (Rachman & Wilson, 1980), and in recent years various groups have brought increased pressure upon psychotherapists to demonstrate that what they do actually works. Such pressures have come from Health Maintenance Organizations, insurance companies, consumer activist groups, and from practitioners and researchers within the field. All of these forces continue to converge on two prominent questions: 1. "Is psychotherapy effective?" and, if so 2. "Are some forms of psychotherapy more effective than others for particular kinds of problems and disorders?" In an attempt to provide some answers to the above questions, the purpose of this Special Issue of the Journal of Cognitive Psychotherapy is to review and disseminate the results of empirically validated treatments of cognitive therapy for particular psychological disorders. In this introductory article we will provide a brief historical overview of research on the effectiveness of psychotherapy in the aftermath of Eysenck's (1952) challenge, discuss some of the criticisms of empirically validated treatments, and finally, provide a brief sketch of the contributors to this Special Issue. THE AFTERMATH OF EYSENCK Following Eysenck's (1952) critique of the effectiveness of psychotherapy, understandably, many people within the field became incensed. However, Eysenck persuaded others that the field of psychotherapy could not live up to its claims of being an effective treatment for psychological disorders. Indeed, those who disagreed with Eysenck believed that his claim took on the stature of a myth (Smith & Glass, 1977). Eysenck (1969) compiled his research results 17 years later and published a book in which he came to the same conclusion as his original work. Hence, a debate within the field emerged with those who were pro and those who were anti-Eysenck. Consequently, for a period of approximately 20 years, Eysenck had effectively challenged the field of psychotherapy to support its claims. Researchers and practitioners did not begin to authoritatively respond to Eysenck (1952) until the 1970s. Bergin (1971), for example, explicated some of the methodological flaws in the Eysenck study. Smith and Glass (1977) provided evidence of psychotherapy's effectiveness through the use of meta-analysis. The organizers of the third edition of the Diagnostic and Statistical Manual of Mental Disorders-DSM-lll (American Psychological Association [APA], 1980) sought to solidify the descriptions and discussions of psychological disorders with more empirical data. The organizers and team researchers of the DSM-III hoped the manual could provide a standardized diagnostic system for use in outcome studies (Nathan & Gorman, 1998). Not all researchers and practitioners were convinced, however, that the responses during the decade of the 1970s had adequately countered Eysenck's (1952, 1969) claims. Rachman (1971), for example, analyzed psychotherapy research results and agreed with Eysenck. In a follow-up volume, Rachman and Wilson (1980) were somewhat more optimistic, but guarded, about the effectiveness of psychotherapy. Indeed, Rachman and Wilson provided a counter criticism of Bergin's (1971) critique of Eysenck. Consequently, at the end of the 1970s, researchers and practitioners within the field still demonstrated doubts concerning the benefits of psychotherapy. In 1986, the American Psychologist published a special issue on outcome research in psychotherapy. …