The flat earth as a metaphor for the evidence for uniform efficacy of bona fide psychotherapies: Reply to Crits-Christoph (1997) and Howard et al. (1997).

On the basis of a meta-analysis of comparisons of bona fide psychotherapies, B. E. Wampold et al. (1997) concluded that the available evidence supported the notion that all psychotherapies are nearly equal in terms of efficacy. K. I. Howard, M. S. Krause, S. M. Saunders, and S. M. Kopta (1997) and P. Crits-Christoph (1997) raised 4 general issues with this conclusion: (a) counterexamples, (b) untested alternative hypotheses, (c) methodological problems, and (d) adequacy of randomized clinical trials. Each of these issues is discussed, and it is asserted that empirically there is no basis to alter the conclusions reached in B. E. Wampold et al.'s (1997) meta-analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Culturally adapted psychotherapy and the legitimacy of myth: A direct-comparison meta-analysis.

Psychotherapy is a culturally encapsulated healing practice that is created from and dedicated to specific cultural contexts (Frank & Frank, 1993; Wampold, 2007; Wrenn, 1962). Consequently, conventional psychotherapy is a practice most suitable for dominant cultural groups within North America and Western Europe but may be culturally incongruent with the values and worldviews of ethnic and racial minority groups (e.g., D. W. Sue, Arredondo, & McDavis, 1992). Culturally adapted psychotherapy has been reported in a previous meta-analysis as more effective for ethnic and racial minorities than a set of heterogeneous control conditions (Griner & Smith, 2006), but the relative efficacy of culturally adapted psychotherapy versus unadapted, bona fide psychotherapy remains unestablished. Furthermore, one particular form of adaptation involving the explanation of illness—known in an anthropological context as the illness myth of universal healing practices (Frank & Frank, 1993)—may be responsible for the differences in outcomes between adapted and unadapted treatments for ethnic and racial minority clients. The present multilevel-model, direct-comparison meta-analysis of published and unpublished studies confirms that culturally adapted psychotherapy is more effective than unadapted, bona fide psychotherapy by d = 0.32 for primary measures of psychological functioning. Adaptation of the illness myth was the sole moderator of superior outcomes via culturally adapted psychotherapy (d = 0.21). Implications of myth adaptation in culturally adapted psychotherapy for future research, training, and practice are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Decision rules for selecting effect sizes in meta-analysis: A review and reanalysis of psychotherapy outcome studies.

This study deals with some of the judgmental factors involved in selecting effect sizes from within the studies that enter a meta-analysis. Particular attention is paid to the conceptual redundancy rule that Smith, Glass, and Miller (1980) used in their study of the effectiveness of psychotherapy for deciding which effect sizes should and should not be counted in determining an overall effect size. Data from a random sample of 25 studies from Smith et al.'s (1980) population of psychotherapy outcome studies were first recoded and then reanalyzed meta-analytically. Using the conceptual redundancy rule, three coders independently coded effect sizes and identified more than twice as many of them per study as did Smith et al. Moreover, the treatment effect estimates associated with this larger sample of effects ranged between .30 and .50, about half the size claimed by Smith et al. Analyses of other rules for selecting effect sizes showed that average effect estimates also varied with these rules. Such results indicate that the average effect estimates derived from meta-analyses may depend heavily on judgmental factors that enter into how effect sizes are selected within each of the individual studies considered relevant to a meta-analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequential analysis applied to counseling process and outcome: A case study revisited.

A case study presented by C. E. Hill et al (see record 1983-10832-001) was analyzed further with sequential analysis methods developed by B. E. Wampold (see PA, Vol 71:30503; in press) and Wampold and G. Margolin (see record 1983-04841-001) to demonstrate the usefulness of these methods for understanding counseling process and outcome. Several interactive patterns were investigated including unidirectional independence, bidirectional independence, and dominance. Process was linked to outcome by examining the relations of various interactive patterns and satisfaction with and evaluation of each session as rated by the client, the counselor, and observers. The present sequential analysis revealed several facets of the interaction between the counselor and the client that were undetected by Hill et al.'s analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The specific ingredients are in the match: Comments on Ahn and Wampold (2001).

H. Ahn and B. E. Wampold (see record 2001-07409-001) reported results of a meta-analysis that included 27 studies conducted between 1990 and 1999. They concluded that the effectiveness of psychological interventions is probably due to general factors, such as the therapeutic alliance, rather than treatment specificity. However, the primary studies included in the meta-analysis evaluated interventions in the abstract, ignoring client and therapist variables that may affect treatment outcome. This abstraction limits the conclusions that can be drawn from the meta-analysis. Issues of validity and bias concerning participant selection and assessment in the primary studies are discussed. It is concluded that further progress will come from evaluation of the client-therapist-intervention match. Therapist and client variables that may facilitate a positive match are described, as are implications for research and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A common factors revolution: Let's not "cut off our discipline's nose to spite its face."

Technique is but one feature, although a very prominent one, of the psychotherapeutic endeavor. Previous attempts by Bruce Wampold and others to downplay psychotherapeutic techniques and to endorse a common factors approach have met with strong scientific and political resistance. However, given the methodological merits of the H. Ahn and Wampold study (see record 2001-07409-001) and the strong programmatic basis for their position, the author does not believe that a methodological debate is warranted. Instead, some of the major economic and professional forces in opposition to a common factors approach to psychotherapy research, practice, and training are outlined. Implications of a common factors revolution, and a proposed alternative, are also explored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

How multiculturalism obscures racial factors in the therapy process: Comment on Ridley et al. (1994), Sodowsky et al. (1994), Ottavi et al. (1994), and Thompson et al. (1994).

Argues that counseling psychologists have prematurely abandoned the study of racial factors in the psychotherapy process in favor of an all-inclusive version of multiculturalism. Using 4 multicultural articles (T. M. Ottavi et al [see PA, Vol 81:31317]; C. R. Ridley et al [see PA, Vol 81:30590]; G. R. Sodowsky et al [see PA, Vol 81:27909] and C. E. Thompson et al [see PA, Vol 81:30597] for illustrative purposes, this article suggests that the definitional imprecision of racial and cultural constructs has contributed to equivocal theoretical conceptualizations, methodological ambiguities, and practitioner confusion. Also, in reaction to the articles, future directions for research on racial factors in the psychotherapy process are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

(Mis-) Direction of effect sizes.

Comments on an article by Dixon et al. (see record 2007-06671-001) regarding the effect sizes they presented in their meta-analysis of psychological interventions for arthritis pain management. The author of this comment claims that some of the individual effect sizes that they presented are erroneous and have therefore undermined their cumulative effect size estimates. After examining findings from other studies, he concludes that the Dixon et al. meta-analysis reports cumulative effect sizes (Hedge’s g) that overestimate the effects of psychological treatments upon arthritis pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Realpolitik and the empirically validated treatment debate.

The impact on Canadian professional psychological treatment practices of the American Psychological Association (APA) Division 12 (Clinical Psychology) Task Force on the Promotion and Dissemination of Psychological Procedures' development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). M. C. King comments on the aforementioned article by expanding on the likely impact of these initiatives on practice patterns of psychotherapy in Canada. The outline of directions for practice in Canada is clearer than Hunsley et al claim, so much so that Canadian developments are quite similar to some of the US directions. King claims that it is essential for Canadian psychology to adhere to the proposed policies, and to shape how they will be used to affect funding of and access to psychological treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An open trial of brief supportive-expressive psychotherapy in the treatment of generalized anxiety disorder.

Conducted a treatment development study applying brief supportive-expressive psychodynamic psychotherapy (P. Crits-Christoph et al; see record 95-195001-002) to the treatment of generalized anxiety disorder (GAD). Background and rationale for the development of this therapy are presented, along with the project's methods and results. Project goals were to develop a treatment manual, train therapists, and assess the treatment's integrity and efficacy. Outcome data on 26 patients (aged 22–64 yrs) with a Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) diagnosis of GAD indicate that the treatment is promising. Patients revealed significant change in anxiety, depression, worry, and interpersonal problems. Ratings of therapist adherence and competence indicate that the treatment manual can be implemented with fidelity and can be discriminated from other treatments. Methodological issues in the planning of treatment research on GAD, particularly the problem of comorbidity, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Deconstructing multicultural counseling competencies research: Comment on Owen, Leach, Wampold, and Rodolfa (2011).

The present article offers a commentary and critique of the research presented by J. Owen, M. M. Leach, B. Wampold and E. Rodolfa (see record 2010-24976-001). Given the complexity of the research methodology, findings, and conclusions, the authors provide a concise summary of findings, study limitations, and conclusions followed by a detailed critique of the study. The authors respect and appreciate the ambitious efforts made by Owen et al. to address gaps in the literature regarding outcome research using client ratings of counselors' multicultural counseling competencies (MCCs). The authors provide a critical analysis of some of J. Owen et al.'s specific conclusions and offer alternative conclusions based on conceptual and methodological bases. The authors use the opportunity to comment on this study as a means of advancing recommendations regarding future research on MCCs that might contribute to substantive revisions to the long-standing theoretical foundation in this area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Graduate training in psychotherapy: Are therapy outcomes enhanced?": Comment on Stein and Lambert (1995).

Comments on the article by D. M. Stein and M. J. Lambert (Journal of Consulting & Clinical Psychology, 1995[Apr], Vol 63[2], 182–296). The authors misunderstood the meta-analysis of P. Crits-Cristoph et al (see record 1992-20595-001) as examining the relation of therapist experience to "therapist effects" (i.e., differences between therapists in their average outcomes). The Crits-Cristoph et al results did not show that experienced therapists had better outcomes than less experienced therapists. It is also noted that the data in Table 3 are, in fact, correct. However, these 2 errors do not affect the main findings of Stein and Lambert's article. (The following abstract of this article originally appeared in PA, Vol 82:26915.) Several sources of indirect evidence supporting the value of graduate training in psychotherapy are reviewed here. Training protocols that are known to enhance trainees' skills are briefly discussed, as are conclusions of meta-analytic reviews examining relationships between therapist experience and training, and therapy outcome. An updated meta-analysis of therapy outcome studies involving within-study comparisons of psychotherapists of different levels of training and experience is summarized.… (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of deficient reporting on meta-analysis: A conceptual framework and reanalysis.

Presents a framework for studying the influence of reporting quality on meta-analytic results in which 3 sources of reporting deficiency are identified: quality (adequacy) of publicizing, quality of macrolevel reporting, and quality of the review process in a different way. To assess the influence of reporting quality empirically, 25 reports were sampled from the psychotherapy meta-analysis reported by M. L. Smith et al (1980) and recorded by the present authors. Two sources of information pertinent to reporting quality were established: interrater reliabilities and confidence judgments. Reanalyses incorporating reliability corrections and confidence judgments suggested that deficient reporting injects considerable noise into meta-analytic data and can lead to spurious conclusions. (43 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cultural difference and the therapeutic alliance: An evidence-based analysis.

The research on positive psychotherapy outcome consistently indicates that the quality of the alliance is important across different models of psychotherapy (D. E. Orlinsky, M. H. Ronnestad, & U. Willutzki, 2004; B. E. Wampold, 2000). Social psychological research has documented how "unintentional bias" can produce barriers to university admissions, employment, and advancement of well-qualified members of ethnic minority groups (J. F. Dovidio, S. L. Gaertner, K. Kawakami, & G. Hodson, 2002). Neuroscience is further confirming social psychological responses associated with race (J. L. Eberhard, 2005). Unintentional bias identified in social psychological research may be part of the psychotherapist/client interaction, interfere with the therapeutic alliance, and partly account for the high dropout rates and underutilization of psychotherapeutic services by people of color. The purpose of this article is to provide an evidence-based analysis of how psychologists in practice may unintentionally interfere with development of quality alliances with culturally different clients or patients and thus contribute to the barriers to effective multicultural counseling and psychotherapy. Principles from the American Psychological Association's (2003) multicultural guidelines and a review of relevant research are applied in suggesting strategies to reduce bias and to develop culturally appropriate skills in psychological practices. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The solution of a dosimetry problem caused by a mercury shutter

Replies to L. E. Beutler et al (see record 1973-31675-001) who presented data in defense of using the number of patients rather than the number of therapists as the unit of analysis for assessing the reliability of process psychotherapy variables. The present paper presents data suggesting that the Beutler et al interpretation of their research findings is not valid. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dropout and therapeutic alliance: A meta-analysis of adult individual psychotherapy.

This meta-analytic review of 11 studies examined the relationship between psychotherapy dropout and therapeutic alliance in adult individual psychotherapy. Results of the meta-analysis demonstrate a moderately strong relationship between psychotherapy dropout and therapeutic alliance (d = .55). Findings indicate that clients with weaker therapeutic alliance are more likely to drop out of psychotherapy. The meta-analysis included a total of 1,301 participants, with an average of 118 participants per study, a standard deviation of 115 participants, and a range from 20 to 451 participants per study. Exploratory analyses were conducted to determine the influence of variables moderating the relationship between alliance and dropout. Client educational history, treatment length, and treatment setting were found to moderate the relationship between alliance and dropout. Studies with a larger percentage of clients who completed high school or higher demonstrated weaker relationships between alliance and dropout. Studies with lengthier treatments demonstrated stronger relationships between alliance and dropout. Inpatient settings demonstrated significantly larger effects than both counseling centers and research clinics. No significant differences were found between client-rated, therapist-rated, and observer/staff-rated alliance. Recommendations for clinicians and researchers are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The cerebral neurobiology of hope and hopelessness

Hope and hopelessness are useful constructs that have been employed by clinicians in theory making regarding the pathogenesis and course of disease and in the application of various psychological and medical treatments to illness. French (1952) and Frank (1968) viewed hope as a necessary motivating force in influencing an individual to try to overcome inner psychological conflicts and seek to resolve a psychoneurosis. Melges and Bowlby (1969) classified the types of hopelessness in psychopathological processes. Perley et al. (1971), using an objective method for content analysis of small samples of speech (Gottschalk 1974), found that elevated hope scores predicted continuation of psychiatric treatment rather than dropping out. Gottschalk et al. (1967, 1969) found that hope scores derived from verbal samples predicted the duration of survival of patients with terminal cancer receiving irradiation treatment (1969) and predicted relatively favorable outcome in psychotherapy (1967).     

"Guidelines for the treatment of depression in primary care" and the APA response.

Comments on the review by R. F. Mu?oz et al (see record 1994-31016-001) of the Agency for Health Care Policy and Research (1993) Depression in Primary Care guidelines, arguing that they were too tactful. It is contended that the guidelines are unfair to psychotherapy, and that Mu?oz et al exaggerate the value of medication and ECT and underestimate their dangers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A test of the fail-safe N for self-help programs.

A meta-analysis of published studies on the clinical efficacy of selected self-help programs (F. Scogin et al; see record 1990-15222-001) indicated that such conditions were more effective than no-treatment controls. Calculation of a fail-safe N showed that 53 nonsignificant studies would have to exist to render the conclusions of the meta-analysis invalid. Results indicate that unpublished research is unlikely to threaten the validity of the original meta-analysis. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reply to comments on Lipsey and Wilson (1993).

Replies to comments by H. J. Eysenck, D. Sohn, and H. Cooper et al (see PA, Vol 82:22192, 22208, and 22189, respectively) regarding Lipsey and Wilson's (see record 1994-18340-001) meta-analysis of meta-analyses. Both Sohn and Eysenck seem to be concerned with how theory is developed, but they may be confused about the role of meta-analysis in that process. It is argued that the purpose of meta-analysis is to develop generalizations about research findings across different studies. The extension of the analysis by Cooper et al reminds researchers that meta-analysis can be subject to error and bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)