Criteria For Evaluating The Outcome Of Treatment

Comprehensive surveys of treatment (Nathan & Gorman, 2002; Roth & Fonagy, 2005) have outlined the minimum criteria against which the efficacy of psychological treatment should be judged. As outlined by Nathan & Gorman (2002) these are as follows. Treatments should be tested by studies that examine groups of patients; the treatment must be more effective than a pharmacological or psychological placebo or similar in effect to an established treatment. Many single cases may suffice. Studies should use good experimental designs and treatment must be capable of being replicated by therapists elsewhere. Instruction manuals may help that.

Kazdin (1994) and Lambert &Hill (1994) emphasise that measures of outcome should be of proven reliability and validity and should be sensitive to change. Kazdin (1994) and Roth & Fonagy (1996) note that several measures are probably necessary to represent all aspects of patients' wellbeing. However, it is then necessary to make sure that change in only a few of several measures is not the result of chance variation. Subjects should be assigned at random to treatments and procedures should be conducted for comparison. Their characteristics, including diagnoses and demographic measures, should be reliably recorded to ensure that the groups are comparable, especially if the samples are small. A sufficiently large number of subjects should be recruited to ensure that the design has sufficient power to reject the null hypothesis if it is false. Studies that meet all these standards are very rare. The outstanding example has been the multicentre trial of cognitive therapy for depression (Elkin, 1994).

Such research should be published in articles which are subject to review by critical experts. However, the editors of prestigious journals receive far too many articles to be able to publish more than a small proportion. Studies are more likely to be published, it is often suggested, if they have a positive outcome, confirming the research hypothesis. Consistent with this, Stern & Jones (1997) found that of 748 proposals for studies that had been passed by an ethical committee at the University of Sydney, those with a positive outcome were most likely to be published. Roth & Fonagy (1996) noted the possibility of such a bias in the treatment studies that they reviewed but there have been few attempts to identify and correct this in psychotherapy research.

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