Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-06-08T19:44:57.683Z Has data issue: false hasContentIssue false

Randomized Clinical Trials in Psychotherapy Outcome Research

Published online by Cambridge University Press:  01 January 2022

Abstract

This paper discusses several philosophical problems with the use of randomized clinical trials (RCTs) in psychotherapy outcome research. The problems include: the impermanence problem, the identification problem, and idiographic problems. The paper concludes with an assessment of the overall case for and against the use of RCTs in psychotherapy outcome research.

Type
Research Article
Copyright
Copyright © The Philosophy of Science Association

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

I would like to thank Barbara Held, Harvey Siegel, Peter Lewis, and two referees for helpful comments.

References

Abel, U., and Koch, U. (1999), “The Role of Randomization in Clinical Studies: Myths and Beliefs”, The Role of Randomization in Clinical Studies: Myths and Beliefs 52:487497.Google ScholarPubMed
Benson, K., and Hartz, A. (2000), “A Comparison of Observational Studies and Randomized, Controlled Trials”, A Comparison of Observational Studies and Randomized, Controlled Trials 342:18781886.Google ScholarPubMed
Braithwaite, R. (1953), Scientific Explanation. London: Cambridge University Press.Google Scholar
Cochrane, A. (1972), Effectiveness and Efficiency: Random Reflections on Health Services. London: Nuffield Provincial Hospital Trust.Google Scholar
Concato, J., Shah, N., and Horowitz, R. (2000), “Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs”, Randomized, Controlled Trials, Observational Studies, and the Hierarchy of Research Designs 342:18871992.Google ScholarPubMed
Davidson, D. (2000), “Mental Events”, in Crumley, J. (ed.), Problems in Mind: Readings in Contemporary Philosophy of Mind. Mountain View, CA: Mayfield Press, 430442.Google Scholar
Erwin, E. (1988), “To Die for Science: Ethical Issues in Placebo Research”, Matchette Lecture, Keynote Address, Conference on Research Ethics, Loras College, Dubuque, IA, April 1.Google Scholar
Erwin, E. (1996), A Final Accounting: Philosophical and Empirical Issues in Freudian Psychology. Cambridge, MA: MIT Press.Google Scholar
Erwin, E. (1997), Philosophy and Psychotherapy: Razing the Troubles of the Brain. London: Sage.Google Scholar
Erwin, E. (2006a), “Research Methods in Psychoanalysis”, in Jokic, A. (ed.), Philosophy of Religion, Physics, and Psychology: Essays in Honor of Adolf Grünbaum. Amherst, NY: Prometheus Books.Google Scholar
Erwin, E. (2006b), “Saving Psychotherapy: The Construction of an Evidence-Based Science”, unpublished manuscript.Google Scholar
Erwin, E., and Siegel, H. (1989), “Is Confirmation Differential?”, Is Confirmation Differential? 40:105119.Google Scholar
Eysenck, H. J. (1952), “The Effects of Psychotherapy: An Evaluation”, The Effects of Psychotherapy: An Evaluation 16:319324.Google ScholarPubMed
Freedman, N., Hoffenberg, J., Vorus, N., and Frosch, A. (1999), “The Effectiveness of Psychoanalytic Psychotherapy: The Role of Treatment Duration, Frequency of Sessions, and the Therapeutic Relationship”, The Effectiveness of Psychoanalytic Psychotherapy: The Role of Treatment Duration, Frequency of Sessions, and the Therapeutic Relationship 47:741772.Google ScholarPubMed
Gergen, K. (1994), Toward Transformation in Social Knowledge. London: Sage.Google Scholar
Grice, J., Jackson, B., and McDaniel, B. (2006), “The Idiographic-Nomothetic Divide: A Follow-up Study”, The Idiographic-Nomothetic Divide: A Follow-up Study 74:11911218.Google ScholarPubMed
Grünbaum, A. (1984), The Foundations of Psychoanalysis: A Philosophical Critique. Berkeley: University of California Press.Google Scholar
Grünbaum, A. (1993), Validation in the Clinical Theory of Psychoanalysis: A Study in the Philosophy of Psychoanalysis. Madison, CT: International Universities Press.Google ScholarPubMed
Grünbaum, A. (2002), “Critique of Psychoanalysis”, in Erwin, E. (ed.), The Freud Encyclopedia: Theory, Therapy, and Culture. New York: Routledge, 117136.Google Scholar
Held, B. (1995), Back to Reality: A Critique of Postmodern Theory in Psychotherapy. New York: W. W. Norton.Google Scholar
Holzman, P. (2002), “Psychopathology”, in Erwin, E. (ed.), The Freud Encyclopedia: Theory, Therapy, and Culture. New York: Routledge, 458460.Google Scholar
Hopkins, J. (1991), “The Interpretation of Dreams”, in Neu, J. (ed.), The Cambridge Companion to Freud. New York: Cambridge University Press, 86135.CrossRefGoogle Scholar
Kaptchuk, T. (2001), “The Double-Blind Randomized, Placebo-Controlled Trial: Gold Standard or Golden Calf?”, The Double-Blind Randomized, Placebo-Controlled Trial: Gold Standard or Golden Calf? 54:541549.Google ScholarPubMed
Kincaid, H. (1996), Philosophical Foundations of the Social Sciences: Analyzing Controversies in Social Research. New York: Cambridge University Press.Google Scholar
Levine, F., Sandeen, E., and Murphy, C. (1992), “The Therapist’s Dilemma: Using Nomothetic Information to Answer Idiographic Questions”, The Therapist’s Dilemma: Using Nomothetic Information to Answer Idiographic Questions 29:410415.Google Scholar
Levy, D. (1996), Freud among the Philosophers. New Haven, CT: Yale University Press.Google Scholar
Mahrer, A. (1988). “Discovery Oriented Psychotherapy Research: Rationale, Aims, and Methods”, American Psychologist 43:694702.CrossRefGoogle Scholar
McIntyre, L. (1996), Laws and Explanations in the Social Sciences. Boulder, CO: Westview Press.Google Scholar
Nagel, T. (1995), Other Minds: Critical Essays 1969–1994. New York: Oxford University Press.Google Scholar
Persons, J. (2006), “Case Formulation-Driven Psychotherapy”, Case Formulation-Driven Psychotherapy 13:167170.Google Scholar
Philips, J. (2005), “Idiographic Formulations, Symbols, Narratives, Context and Meaning”, Idiographic Formulations, Symbols, Narratives, Context and Meaning 16:180184.Google Scholar
Salmon, W. (1984), Scientific Explanation and the Causal Structure of the World. Princeton, NJ: Princeton University Press.Google Scholar
Sandell, R., Blomberg, J., Lazar, A., Carlsson, J., Broberg, J., and Schubert, J. (2000), “Varieties of Long-Term Outcome among Patients in Psychoanalysis and Long-Term Psychotherapy: A Review of Findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP)”, Varieties of Long-Term Outcome among Patients in Psychoanalysis and Long-Term Psychotherapy: A Review of Findings in the Stockholm Outcome of Psychoanalysis and Psychotherapy Project (STOPP) 81:921942.Google Scholar
Seligman, M. (1995), “The Effectiveness of Psychotherapy: The Consumer Reports Study”, The Effectiveness of Psychotherapy: The Consumer Reports Study 50:965974.Google ScholarPubMed
Shapiro, A., and Morris, L. (1978), “The Placebo Effect in Medical and Psychological Therapies”, in Garfield, S. and Bergin, A. (eds.), Handbook of Psychotherapy and Behavioral Change. New York: Wiley, 369410.Google Scholar
Sober, E. (1990), “Let’s Razor Out Ockham’s Razor”, Let’s Razor Out Ockham’s Razor 27:7393.Google Scholar
Taylor, C. (1985), “Interpretation and the Sciences of Man”, in Philosophy and the Human Sciences: Philosophical Papers, Vol. 2. New York: Cambridge University Press, 1557.CrossRefGoogle Scholar
Office of Technology Assessment U.S. Congress (1978), Assessing the Efficacy and Safety of Medical Technologies. Washington, DC: U.S. Government Printing Office.Google Scholar
Office of Technology Assessment U.S. Congress (1994), Identifying Health Technologies That Work: Searching for Evidence. OTA-H-608. Washington, DC: U.S. Government Printing Office.Google Scholar
Wilson, G. T. (1996), “Manual-Based Treatments: The Clinical Application of Research Findings”, Manual-Based Treatments: The Clinical Application of Research Findings 34:295314.Google ScholarPubMed
Windelband, W. (1998), “History and Natural Science”, History and Natural Science 51:236258.Google Scholar
Worrall, J. (2002), “What Evidence in Evidence-Based Medicine?”, What Evidence in Evidence-Based Medicine? 69 (Symposium): S316S330.Google Scholar
Wundt, W. ([1897] 1969), Outlines of Psychology. Reprint. Translated by C. Judd. Originally published as Grundriss der Psychologie (Leipzig: Wilhelm Engelmann). St. Claire Shores, MI: Scholarly Press.Google Scholar