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A Look at the Evidence: Top 10 Research Findings of the Last 25 Years

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face=+Bold; A Look at the Evidenceface=-Bold; face=+Italic; Top 10 research findings of the last 25 yearsface=-Italic;

face=+Italic; by face=-Italic; Jay Lebow

How much does empirical research direct the way therapists actually practice? Most surveys indicate that clinicians regard other sources of information, such as supervision and their personal experience of therapy, as being far more important than formal research studies in influencing how they work with their clients. That's unfortunate because the last quarter-century has produced an astonishing amount of meaningful research demonstrating not only the overall effectiveness of psychotherapy, but the positive impact of specific therapeutic methods with particular disorders. To give you an idea of how far the marriage of research and therapy has advanced, here are my choices of the 10 most significant developments in the field that research has documented during the last 25 years:

face=+Bold; 1face=+Italic; Psychotherapy has been shown to be at least as effective as medication in treating such common psychiatric diagnoses as dysthymic disorder, generalized anxiety disorder, and chemical dependency.face=-Italic; face=-Bold; Metanalyses of psychotherapy studies, such as those conducted by Mary Lee Smith, Gene Glass, and Thomas Miller in the early 1980s, show that individual, group, and family therapies alike have large statistical and clinical effects. Furthermore, in a survey conducted by psychologist Martin Seligman for face=+Italic; Consumer Reports face=-Italic; in 1995, the great majority of respondents reported positively of their psychotherapy experience, showing unusually high levels of consumer satisfaction.

Perhaps the best single demonstration of the impact of psychotherapy was the Treatment of Depression Collaborative Research Program (TDCRP), a methodologically rigorous study initiated by Irene Elkin of the National Institute of Mental Health and her colleagues in the 1980s that compared psychotherapy and medication head to head in the treatment of people suffering from depression. In the study, two psychotherapies--Interpersonal Psychotherapy (a variant of psychoanalytic psychotherapy developed by Myrna Weissman and Gerald Klerman) and cognitive therapy (developed by Aaron Beck)--were shown to work as well on depression as medication, even though the study was done in the short-term format typical of medication-only studies. This superbly constructed research study left no doubt that psychotherapy has an impact comparable to that of medication in treating serious mental health problems.

face=+Bold; 2face=+Italic; Specific treatments have been identified for specific disorders.face=-Italic; face=-Bold; In the first 75 years of its history, psychotherapy consisted of a general set of principles applied to just about everybody, with only a secondary focus on matching treatment to the client's particular difficulty. The emergence of empirically supported treatments (ESTs) has moved one sector of psychotherapy away from that generalized focus toward specific treatments for specific problems. Today there are more than a hundred ESTs, each having a demonstrated impact on a problem or syndrome, ranging from adult substance use disorders, to childhood oppositional disorder, variants of depression and anxiety, eating disorders, and general health problems. Examples of particularly well established treatments include Beck's Cognitive Therapy and Wiessman and Klerman's Interpersonal Therapy for depression; David Barlow and Michele Craske's Panic Control Treatment for panic disorder; Edna Foa's exposure and ritual-prevention therapy for obsessive-compulsive disorder; Tom Borkovec's Cognitive-Behavioral Therapy (CBT) for generalized anxiety disorder; and 12-step and CBT treatments for substance-use disorders.

face=+Bold; 3face=+Italic; Brief, targeted interventions have proven effective across a broad spectrum of problems.face=-Italic; face=-Bold; Twenty-five years ago, psychoanalytic psychotherapy was still in its heyday and was, for the most part, not subjected to empirical testing--perhaps because it just wasn't clear how to test a modality that was so subjective and nebulous. …