EST's

With so much variability in symptoms and behaviors within particular psychological disorders, it makes sense that researchers and clinicians are identifying more specific treatments that target specific behaviors. However, standards for evaluating the effectiveness of these treatments are necessary and the Chambless & Hollon (1998) article attempts to provide structure for us in doing so. The authors acknowledge the complexity and magnitude of this task and point out that many disagreements will likely arise. Therefore, I'd like to point out a few of my concerns with their guidelines. First, the authors deviate from guidelines set forth by the Division 12 Task Force and state that "...if a treatment works, for whatever reason, and if this effect can be replicated by multiple independent groups, then the treatment is likely to be of value clinically..."(pg. 8). I do not think its enough to know simply that a treatment works. In fact, merely proving that a treatment is more beneficial than no treatment at all seems to be assuming psychotherapy equivalence, which is a questionable theory discussed in the Hunsley & DiGiulio (2002) article. Researchers should be able to identify a treatments' specific nature and the mechanisms underlying the particular treatment's success in improvement. Because there could be so many external factors for a client's improvment other than the treatment itself, evidence of treatment specificity seems essential to me.

Another concern I had involves the specification of a treatment population. While I agree with the authors that it is necessary to show that a treatment is efficacious for a particular group of poeple, I had some issues with their emphasis on the diagnostic criteria in the DSM as the means for defining a population. As we talked about last week, people with the same diagnoses could manifest very different symptoms (or at least the degree of the manifestation of certain symptoms could be different) and thus respond very differently (or not at all) to the same treatment. For instance, people with social skills problems could be exhibiting social problems because of an actual social skill deficit and would respond well to social skills training, wheras others may be experiencing soical problems due to social anxiety and would respond well to both systematic desensitization or social skills training (Trower, 1978)--this was actually an example put forth in an article for our assessment class called "The Treatment Utility of Assessment" (Hayes, Nelson, & Jarrett, 1987) which fits pretty nicely into this week's topic. In any case, while Chambless & Hollon (1998) do acknowledge other factors that should also be considered such as comorbidity and the age range of a population, I'd like to see more emphasis placed on defining treatment samples based on symptom homogeneity, not just diagnoses.