Some General Conclusions
Although most acknowledge that the efficacy of
psychotherapy has been demonstrated, there is little
evidence to suggest that one form of therapy is in
any sense uniquely effective for all problems. J. D.
Frank’s (1979) conclusions about psychotherapy
several decades ago also seem to characterize cur-
rent thinking:
- Several forms of psychotherapy are somewhat
more efficacious than unplanned or informal
help. - One form of therapy has typically not been
shown to be more efficacious than another for
all conditions. - Clients who show initial improvement tend to
maintain it.
Careful research should be designed to help us
predict which therapy will best work for a given
problem. Lists of empirically supported treatments
for common psychological problems should con-
tinue to be updated and expanded. At the same
time, effort should also be devoted to investigating
the factors common to all therapies and the manner
in which they operate. Research might also focus
on the effects of matching patients and therapists in
terms of relevant characteristics. However, in the
final analysis, therapist competence may be more
critical than the simple matching of patients and
therapists along lines of race, class, or sex.
Therapy is an intermittent process that occurs,
for example, once a week. Thus, it is only a small
part of a client’s ongoing life. Other concurrent
experiences may be as important or even more
important in determining whether or not improve-
ment occurs. Also, what happens in therapy may
interact with other experiences in complex ways.
Others may begin to react differently to the client,
and these changed reactions may reinforce or coun-
teract changes induced by therapy. Changes in the
client may threaten family members, who then qui-
etly conspire to sabotage treatment. The whole
process is so complex and interactive that it is diffi-
cult for research to show what factors in therapy are
related to client change or lack of it (Frank, 1982).
Perhaps the greatest reality limitation of all is sug-
gested by Barlow’s (1981) charge that many clinical
psychologists simply do not pay attention to outcome
research. They continue doing what they have always
done without full realization of the difficulties in mak-
ing valid inferences from their experiences with single
cases (Kazdin, 1981). Persons (1995) discusses how
deficits in training and the perceived inaccessibility
of resources have caused clinicians to delay adopting
empirically supported treatment techniques. How-
ever, Chambless et al. (1996) have said it best:
Psychology is a science. Seeking to help
those in need, clinical psychology draws its
strength and uniqueness from the ethic of
scientific validation. Whatever interventions
that mysticism, authority, commercialism,
politics, custom, convenience, or carelessness
might dictate, clinical psychologists focus on
what works. They bear a fundamental ethical
responsibility to use where possible inter-
ventions that work and to subject any inter-
vention they use to scientific scrutiny. (p. 10)
Clinical psychologists must learn more about
the specifics of the efficacy and effectiveness of var-
ious forms of therapy and routinely implement this
knowledge. They are under both ethical and scien-
tific imperatives to do so.CHAPTER SUMMARY
Clinical psychologists use psychological interven-
tions to induce changes in a person’s behavior,
thoughts, or feelings. Psychotherapy is a form of
intervention that occurs in a professional context
whose aim is to solve psychological problems,
improve coping and functioning, prevent future
problems, or increase life satisfaction. Evidence sug-
gests that psychotherapy is efficacious, especially for340 CHAPTER 11