If therapists were athletes and the model was a javelin, say. And you wanted to work out if one javelin was better than another, and you spent 50 years looking at that question, always thinking it was the javelin, not the athlete, that was getting the results, you'd look pretty silly wouldn't you?
Imagine testing a javelin by randomly assigning athletes, from little athletics level through to Olympic level, without realizing that some were better than others..... getting small statistical differences between this brand of javelin and that one. Then javelin throwers get on the bandwagon and all the really serious ones bought the better javelin, then all of a sudden the better javelin was more obviously better, but we tell ourselves that was just because this new study design was better.
If anyone teaches undergraduates it would be a fun project. Get all the stats for world class javelin players and find out what javelins they use then divvy up the data that way and call yourself a psychotherapy researcher.
Think that's absurd?
Here's my plea. All new studies of psychotherapy effectiveness should not be funded unless they include therapist effectiveness in their study design, and measure this. What do you think?
Cuijpers P. The future of psychotherapy research: stop the waste and focus on issues that matter. Epidemiol Psychiatr Sci. 2016 Aug;25(4):291-4. https://www.cambridge.org/core/services/aop-cambridge-core/content/view/145D8648ADCE91FC6C47F83A8B3F9091/S2045796015000785a.pdf/the-future-of-psychotherapy-research-stop-the-waste-and-focus-on-issues-that-matter.pdf
Shean G. Limitations of Randomized Control Designs in Psychotherapy Research. Advances in Psychiatry 2014; Article ID 561452. https://www.hindawi.com/archive/2014/561452/
Thank you, some useful references, but my sense is that both discussions are about shifting the deck chairs on the titanic. As in, still speaking from within the old paradigm where psychotherapy research has not improved outcomes in the last 50 years.
allegiance is one of the more interesting findings I think. That a therapist believes that what they do will work, accounts for about 69% of the variance of outcome variance, but in RCT,s it is controlled for, rather than investigated.
To use my athlete metaphor, this would be like handicapping an athlete who is over performing and making one javelin look better than the other.
Hi Martin,
Thanks for the leads on the articles. I regards to the second article, my hope is that we can gain a consensus among scholars that acknowledges these limitations, and then designs different studies. Then what to study is a matter for greater minds than myself, but i want to think that good science comes from being faced with the unknown. I think that is where Gabrielle's question is trying to get at.
I've only just glanced through the introduction on the editorials in your first reference above. I like the emphasis in the title about "stopping the waste". I believe that should be an ethical consideration for researchers....I will look to the other articles in the hope that there is something to add to a growing consensus among scholars about the future of psychotherapy research. We hope our efforts will assist moving that consensus along in advancing psychotherapy research.
Cheers,
J
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