The effectiveness of psychotherapy: the Consumer Reports study

“…& Kisely, 2006; Anderson & Lambert, 1995; de Maat, de Jonghe, Schoevers, & Dekker, 2009; Leichsenring & Rabung, 2008; Sandell et al., 2000; Seligman, 1995, Smith, Glass, & Miller, 1980), the evidence-based treatments that are increasingly demanded by third-party payers and some (primarily…”

“Therefore, how efficacy is measured and whether these measures are consistent with the patient become critical factors in determining patient treatment satisfaction (Seligman, 1995).”

“Yet, given evidence that long-term therapies may be more effective than short-term therapies (Howard, Kopta, Krause, & Orlinsky, 1986; Orlinsky, Grawe, & Parks, 1994; Seligman, 1995), it seems worthwhile to develop cost-effective, alternative ways to study the relationship between prescribed therapeutic processes and…”

“We conclude that the majority of studies have poor design in relation to the methodological demands for both efficacy and effectiveness studies (Begg et al., 1996, Kazdin, 1994; Seligman, 1995).”

“A common criticism of treatment research, in psychotherapy trials in general and PTSD trials specifically, is that randomized controlled trials do not include complex, comorbid patients and thus are not generalizable to broader clinical populations (e.g., Seligman, 1995; Westen, 2006).”

“…Muran, 2001; Neimeyer & Raskin, 2000; Norcross, 1986, 2002; Norcross & Beutler, 2000; Ochsner & Lieberman, 2001; Prochaska & Norcross, 1999; Roth & Kulb, 1997; Seligman, 1995; Shealy, 1995, 2002; Sternberg & Grigorenko, 2001; Strupp, 1986, 1996; Wachtel, 1997; Wolfe, 2000; York & Cooper, 2001).”

“…who actively explore treatment options, inquire about therapeutic practices, seek to understand their roles in psychotherapy, and participate in the therapeutic process are likely to have more beneficial outcomes (Arnkoff et al., 2002; Luborsky, 1971; Orlinsky et al., 1994; Seligman, 1995, 1996).”

“The quality of the therapeutic relationship is crucial to positive outcomes across different psychotherapies.(74,75) Palliative care providers who are able to establish good therapeutic relationships are more likely to reduce suffering of patients and their families.”

“Coinciding with these developments was the publication of the well-known and somewhat controversial Consumer Reports study (Seligman, 1995), which further contributed to dialogues regarding efficacy versus effectiveness studies and the tension between internal and external validity (Goldfried &…”

“Convergence of present findings with theory and process-outcome research supports the validity of consumer perspectives (Duncan & Miller, 2000; Macran, Ross, Hardy, & Shapiro, 1999; Seligman, 1995; Wampold, 1997).”

“As Seligman (1995), who upon reading the Consumer Reports national survey on psychotherapy, commented about the “gold standard” of effectiveness studies being good methodology for “some” questions but of little information value in determining what is really going on with real clients with real…”

“The treatment literature (e.g., Seligman 1995) draws a distinction in treatment research between efficacy studies (high internal validity based on experimental rigor including RA) and effectiveness studies (high external validity at the cost of some internal validity).”

“However, the number of people in the general population who have an experience of premature dropout from psychotherapy is to our knowledge not known and could be investigated as was done long ago with regards to therapy experiences in the Consumers Report study (Seligman, 1995).”

“These problems have been broadly criticized in psychotherapy research, leading to the view that the ‘‘generalization’’ from the setting of a controlled randomized psychotherapy study to the setting of routine practice is generally not justified because the routine practice is described by boundary conditions that have…”

“Requisitos convenientes en los ensayos clínicos sobre la efi cacia de tratamientos (modifi cado de Seligman, 1995) • Asignación aleatoria de los pacientes (no sujetos análogos) a las condiciones experimentales y de control.”

“Further, real-life clients often struggle withmultiple issues rather than a single psychological disorder (Westen et al., 2004), and in turn desired outcomes may include overall improvements in functioning rather than only symptom reduction (Seligman, 1995).”

“Recent studies provide empirical evidence that indicates the benefit of long-term treatments (Freedman et al. 1999; Sandell et al. 2000; Seligman 1995).”

“which may help empower them by counteracting demoralization and satisfying their treatment preference (Corrigan and Salzer, 2003; Seligman, 1995).”

“Clients typically have multiple problems, an issue also known as ‘comorbidity’ (Seligman, 1995).”

“Email: schindam@uni-mainz.de ISSN 1050-3307 print/ISSN 1468-4381 online # 2011 Society for Psychotherapy Research http://dx.doi.org/10.1080/10503307.2011.602750 between efficacy and effectiveness studies (Persons, Bostrom, & Bertagnolli, 1999; Seligman, 1995; Westbrook & Kirk, 2005).”

“…the superiority of efficacy research, and have suggested effectiveness research, where outcome research is performed in a real-world setting, as an alternative and/or a complement to efficacy research (Andrews, 1999; Beutler & Howard, 1998; Clarke, 1995; Pinsof & Wynne, 1995a; Seligman, 1995).”

“An independent North American consumer organization asked more than 4000 “psychotherapy consumers” if they had received what they needed in their psychotherapies (Consumer Reports 1995; Seligman 1995, 1996).”

“The Consumer Reports Study’ (Seligman, 1995).”

“General trends are also necessary to provide legitimation of efficiency and effectiveness of leadership interventions (as done with psychotherapy, Seligman 1995).”

“Consumer ratings are a useful form of evidence about treatments as used in real-world settings, complementary to the more rigorous but artificial RCT (Seligman, 1995).”

“However, the exclusive position of RCTs as methods for demonstrating that a treatment works has been questioned (Beutler, 1998; Fonagy, 1999; Persons & Silberschatz, 1998; Roth & Parry, 1997; Seligman, 1995).”

“Seligman (1995) pointed out that the clinical reality of psychotherapy is that it is generally not of fixed duration, but continues until symptoms have abated or until the patient terminates the therapy.”

“Although clients in efficacy studies typically enter treatment passively through random assignment, clients in routine clinical practice see a treatment provider after actively shopping either for a type of treatment or a specific therapist (Seligman, 1995).”

“respond to unexpected events that often occur when conducting psychotherapy with people, that is, we can improvise to meet participant needs[57,58].”

“…and early 1980s, the research has clearly shown that psychotherapy, including traditional approaches, is robustly effective (Bergin & Lambert, 1978; Grissom, 1996; Lambert & Bergin, 1994; Lipsey & Wilson, 1993; Seligman, 1995; Smith, & Glass, 1977; Smith, Glass, & Miller, 1980; Wampold, 2001).”

“While this lack of standardization made rigorous outcome studies difficult, it had the advantages of allowing the instructors to work from their strengths, thereby possibly increasing the quality of the intervention, and allowing for self-correction ( Seligman, 1995 ), that is, instructors could alter an activity if i…”

“In a landmark and controversial American Psychologist article analyzing and interpreting the results of the 1995 Consumer Reports survey of psychotherapy effectiveness, Seligman (1995) argued for effectiveness studies by listing five limitations of efficacy studies (Appendix A).”

“Addressing additional concerns, Seligman (1995) critiqued the effectiveness of psychotherapy, concluding that the ideal study should combine the best features of the survey method, be conducted in a naturalistic setting, and measure multiple outcomes, including both improvement and global gains…”

“…I syndromes . . . do not address enduring personality dispositions relevant to these syndromes” (p. 648), while virtually all naturalistic studies show greater improvement with more extensive treatment, especially when characterological problems are present (Howard et al., 1986; Seligman, 1995).”

“…have evaluated child and caregiver outcomes, few have examined how adherent “real world” therapists are to the content of the treatment models they apply in routine sessions due to the difficult evaluation process (Baker-Ericzen, Hurlburt, Brookman-Frazee, Jenkins, & Hough, 2010; Seligman, 1995).”

“…2000; McDermut, Miller, & Brown, 2001; Miller & Wilbourne, 2002; Moyer, Finney, Swearingen, & Vergun 2002; Prendergast, Podus, & Chang, 2000; Seligman, 1995; Shadish et al., 1993, 1997; Stanton & Shadish, 1997; Wilson, 2000) that inform policy makers on whether psychotherapy of a particular…”

“The present studies contain elements common in effectiveness studies (Seligman, 1995).”

“And although such knowledge may be fallible, surveys indicate it is still quite useful despite professional differences (Seligman, 1995).”

“As Seligman (1995) pointed out in his article describing the differences between effectiveness and efficacy studies, there are a number of issues that may be overlooked in controlled trials, the most salient being that (a) in clinical practice, treatment usually is not of fixed duration; (b) treatment may be self-corr…”

“The strict inclusion/exclusion criteria of most RCT designs may result in a selection-biased sample, unrepresentative of the broader clinical population.([3,5,6]) Similarly, the recruitment strategies for RCTs, which usually involve advertising and active participant solicitation, may attract a different type of perso…”

“De nombreuses caractéristiques sont opposées dans ces deux situations : ainsi, en situation de recherche, le diagnostic des patients est unique, tandis qu’il est multiple dans la situation clinique habituelle ; les objectifs diffèrent également, objectifs spécifiques de recherche dans un cas, objectifs du patient dans…”

“…more about counselling/ psychotherapy (for example, Caskey et al. 1985; Lietaer and Neirinck 1986; Martin and Stelmaczonek 1988; Llewelyn 1988; Rennie 1990; Hill et al. 1993; Watson and Rennie 1994; Seligman 1995; Paulson et al. 1999, 2001; Etherington 2000; Ryden and Loewenthal 2001).”

“For the clinician, client feedback is the primary guide to treatment choice and therapeutic practice (also see Seligman, 1995).”

“While efficacy studies assist in ascertaining the effects of an intervention in a controlled clinical context, effectiveness research is commonly conducted in routine care facilities using real-world clinicians and clients who have multiple diagnoses and needs (Seligman, 1995).”

“This might represent a ceiling effect where individuals with more severe symptoms may show larger improvements (Seligman, 1995) or a regression toward the mean (Nesselroade, Stigler, & Baltes, 1980), but it is also possible that the participants who reported high levels of symptomatic change were more open and less pr…”

“It attempted to ameliorate the disorder and presented symptoms while also improving the resident’s general level of functioning in the LTC facility (Seligman, 1995).”