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November 1981

Efficacy of PsychotherapyAsking the Right Questions

Author Affiliations

From the Mental Health Study Center, National Institute of Mental Health, East Adelphi, Md (Dr Greenspan), and the Department of Behavioral Medicine, National Institute of Mental Health, Bethesda, Md (Dr Sharfstein).

Arch Gen Psychiatry. 1981;38(11):1213-1219. doi:10.1001/archpsyc.1981.01780360029002

• Economic pressures and "value" judgments both compel and contaminate the current debate on the efficacy of psychotherapy. Too often, complex clinical trial outcome studies ignore the clinical or treatment process, as well as personality or contextual variables. Thus, they fail to build the foundations of a clinical science that makes possible the development of individually tailored treatment approaches and outcome predictions for specific patients with unique personalities, symptoms, and life circumstances. The real challenge, therefore, is for each psychotherapeutic approach to delineate its "process steps" and relate these steps to different outcomes. The "process" is the "final common pathway" for a number of patient, therapist, technique, and contextual variables. The capacity to predict the relationship between process and outcome at each stage in a therapeutic procedure is the relevant clinical test of "efficacy."