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Implications of psychotherapy research for psychotherapy training.

This review article considers implications of psychotherapy research for psychotherapy training. It considers 8 themes that characterize the research literature. The themes involve outcome findings, common factors, empirically supported therapies, patient treatment matches, therapy manuals and practice guidelines, brief therapies, combinations of medication and psychotherapy, and group therapies. Each theme represents a controversial issue that has implications for the content of contemporary psychotherapy curricula. To assist trainees in becoming well-informed therapists, themes and implications such as these should be covered as part of their introduction to learning about the psychotherapies. To understand the themes and implications, as well as new findings that continually emerge from the research literature, trainees also need to be familiar with basic research methods and evaluative criteria, subjects that can also be covered as part of their introduction to the psychotherapies. As their training proceeds, research findings can be integrated with the development of their clinical skills in a broad range of psychotherapies.

Education↗

[Psychotherapy research and child psychotherapy practice].

Psychotherapy research results are viewed under the aspect of relevance and irrelevance for psychotherapeutic practice. The difficulties to develop effective research designs for children, and adolescents are described, and possible research perspectives are developed for this complex domain. Especially the amount of variables in combination with developmental stages of children, and adolescents creates extreme difficulties to develop research designs to give an answer to the question, which therapeutic approach is better than others in the near future. Some conclusions from research results are made for psychotherapeutic practice.

Adolescent↗

The care and feeding of a psychotherapy research team.

Although psychotherapy research teams have been in existence since the 1940s, one of the reasons they are not more popular is the absence of literature on how they operate. There is essentially no literature on the organization and administration of psychotherapy research teams, on the management of their everyday practical issues, decisions, and problems. In order to open the way for a dialogue on these matters, an inside view is provided of one relatively productive psychotherapy research team. The topics include the mission and goal, nature and size of the team, administrative locale, team contract, meetings and homework, leadership and decision-making, the research tape library, and what team members get from participation on the team.

Clinical Competence↗

[Evaluative psychotherapy research: clinical relevance of psychotherapy catamnesis].

In this article we will depict the relevance of follow-up studies for evaluative psychotherapy research. Follow-up studies distinguish themselves from pure result studies in that they are clinically more meaningful as they examine the stability of psychotherapy results over a longer period of therapy-free time. The special methodical problems of follow-up studies are discussed and the minimal essentials for the research design of such studies are called for.

Follow-Up Studies↗

[Psychotherapy research and therapeutic management].

The history of psychotherapy research has been closely allied with the development of clinical practice, as this review demonstrates. Empirical psychotherapy research aims at the scientific evaluation of existing practice and at the discovery of new fields of application. The early phases of psychotherapy research were concerned with scientific justification and societal legitimation. These questions changed with the extension of possible indications, the growing differentiation of treatment procedures and the progressive implementation of psychotherapy within the health-care system. The early issue "does psychotherapy work at all?" has been replaced by the questions "to whom is psychotherapy helpful?" and "how does psychotherapy work?". As an established part of the health-care system, psychotherapy is now faced with the same urgent problems as other medical specialties: therapeutic goals and economic conditions have to be brought in balance. Thus the perspectives of psychotherapy research have to encompass the individual patient as well as the system of care. These demands create new questions which enlarge the approaches of traditional psychotherapy research; new structural and logistic methodologies are asked for. We conclude by referring to a multicenter study on the psychodynamic treatment of eating disorders that has been initiated by the Center for Psychotherapy Research in Stuttgart as a prototype form of the new look in psychotherapy research.

Anorexia Nervosa↗

[Qualitative psychotherapy research in German speaking countries].

OBJECTIVES: The subject of this paper is a review of qualitative research in psychotherapy and psychosomatic medicine in German speaking countries. METHODS: A short systematic survey of the relevant topics is given. RESULTS: The methodology and methods are reviewed as well as subjects and results, e.g. first interview and diagnostics, psychosomatic disorders, research into the course of psychotherapy, patient-therapist-interaction, and follow-up investigations. DISCUSSION: We briefly examine the historical and sociological backgrounds most relevant for the development of qualitative psychotherapy research.

Europe↗

[Configural methods of assessment in psychotherapy research].

The particularity of psychotherapy research implies the application of configural techniques, with respect to the developmental state of theory generation in psychotherapy especially inductive configurational approaches like GUHA or HYPAG/Search. Each variant of HYPAG (i. e. Search for non-disjunctive types, explanations of multiple relationships, elaboration of theory-related optimal suggestions for operationalization) are presented in detail and demonstrated with secondary analyses. The main problem of this approach is the requirement of large numbers of subjects. The application of this approach can hardly be recommended with less than 250 subjects.

Follow-Up Studies↗

Getting our act together: lessons on meaningful psychotherapy research from the philosophy of science.

Psychotherapy research should concentrate on building up a scientifically validated, theoretical knowledge base by means of disciplined empirical research. The normal nested relationship between technology, theory, and research has not been the norm in the world of psychotherapy. Psychotherapy researchers should learn from the history of science and concentrate on building basic theory. Investigations into the causal relations underpinning psychotherapy is the best way that research can help us do psychotherapy better. These investigations must conform to the canons of inductive reasoning. Conventional use of clinical data to underwrite psychotherapeutic theory is vulnerable to Grünbaum's critique. A research proposal based on Langs' communicative approach to psychotherapy is presented predicting measurable unconscious responses to brief, time-limited psychotherapy.

Humans↗

The ecology of psychotherapy research.

The ecology of psychotherapy research was examined with patient reports of demand characteristics and awareness of research instrumentation. Patients were part of the Vanderbilt II project that explored the effectiveness of manualized training. A total of 59 patients from the pretraining and posttraining phases of the project were interviewed after termination assessments were made. Patients who were highly aware of their role as a "subject" in an experiment had outcomes that were consistent with the primary hypotheses of the study, although training did not significantly improve outcomes. In the pretraining cohort, patients who were highly aware of their "subject" role had poorer outcomes and engaged less in exploratory process. In the posttraining cohort, patients who were highly aware had good outcomes and engaged in more exploratory processes. Interestingly, therapists of these patients offered a positive relationship but failed to adhere to the principles taught during training. Demands of the research, especially how the patient defines his or her role, may affect results in significant ways.

Female↗

Evaluating empirically based psychotherapy research for children and adolescents.

Psychotherapy research improved its methodological rigor in the last half of the past century and as we begin a new millennium and a new generation of research it is important to evaluate its effectiveness. In this article the historical perspective of psychotherapy evaluation is reviewed, followed by the presentation of the Child Task Force criteria for evaluating psychotherapy outcomes. The results of the American Psychological Association Task Force review of well-established and probably efficacious treatments for depression, anxiety, disruptive behavior disorders and attention deficit hyperactivity for child and adolescent disorder are presented. Finally, the advantages and disadvantages of these very structured criteria for evaluating psychotherapy research with children and adolescents are discussed, and future directions are proposed.

Adolescent↗

Researching psychotherapy effectiveness in mental health service agencies.

The results of psychotherapy outcome research to date are briefly reviewed and the reasons why this research has not had greater impact on the practice of psychotherapy in mental health service agencies are presented. Sources of pressure to conduct evaluation research are enumerated. Involving mental health practitioners in field research is proposed as a means of increasing the relevance of psychotherapy outcome research to service personnel. Difficulties frequently encountered in the planning, data gathering, and implementation of results phases of evaluation projects are discussed and recommendations are made for ameliorating these problems. An improvement-oriented feedback model of program evaluation is presented and the value of individualized measurement, repeated-measures designs, and experimental case studies in maximizing the utilization of research results are discussed.

Data Collection↗

Psychotherapy research: basic or applied?

Borkovec and Miranda (1996) have argued that the "greatest progress in the development of increasingly useful interventions" (p. 14) will come from redefining comparative trials research on psychotherapy outcome as basic research. They foresee that such a reconceptualization will lead to the increased use of dismantling, parametric, and additive research strategies and that it will result in increasing collaboration with other basic researchers. The assumption that a redefinition will stimulate increased collaboration and specificity of causal mechanisms is questioned as are the assumptions that randomization, group comparison designs, and within therapist designs will lead inherently to more valid assessments of cause-effect relationships. Analyses of a randomized clinical trials study is used to illustrate how clinical research can be guided by theory to tease out causal relationships, within therapy, and within patient factors. Ultimately, a combination of research paradigms, including N = 1, clinical utility, and controlled research, will best provide answers to important questions of change mechanisms and treatment effectiveness. A simple reconceptualization, however, is not necessary to make this happen and belies the complexity and overlap of the problems to be addressed.

Humans↗

How to do discovery-oriented psychotherapy research.

A discovery-oriented approach to psychotherapy research relies on discovery-oriented research questions. Four such questions are illustrated, together with the logistics of this approach to research, and the practical working steps in carrying out a program of discovery-oriented research. A case is made for the superior elegance of the discovery-oriented approach to psychotherapy research.

Adaptation, Psychological↗

Methodological pluralism: a framework for psychotherapy research.

A new level of sophistication is advocated for psychotherapy research--methodological pluralism. This pluralism recognizes the number of unexamined and untested assumptions that are embedded within any method, including traditional scientific methods. These assumptions restrict the questions that can be asked and the variables that can be tested before any investigation of psychotherapy has occurred. Such premature closure is ultimately unscientific and hinders truly creative investigations of psychotherapy. Consequently, a framework is described that allows multiple methods--with multiple underlying philosophies--to complement one another in psychotherapy research. Five essential benefits of this pluralistic framework are shown: advancement of science, increased objectivity, a level playing field, greater scientific freedom, and an end to the burgeoning "method wars" of psychotherapy research.

Cultural Diversity↗