▪ Abstract Efforts to increase the practice of evidence-based psychotherapy in the United States have led to the formation of task forces to define, identify, and disseminate information about empirically supported psychological interventions. The work of several such task forces and other groups reviewing empirically supported treatments (ESTs) in the United States, United Kingdom, and elsewhere is summarized here, along with the lists of treatments that have been identified as ESTs. Also reviewed is the controversy surrounding EST identification and dissemination, including concerns abou research methodology, external validity, and utility of EST research, as well as the reliability and transparency of the EST review process.

Empirically Supported Psychological Interventions: Controversies and Evidence

Part I: Foundations and the Model. The Dilemma of Human Suffering. The Foundations of ACT: Taking a Functional Contextual Approach. Psychological Flexibility as a Unified Model of Human Functioning. Part II: Functional Analysis and Approach to Intervention. Sandoz, Case Formulation: Listening with ACT Ears, Seeing with ACT Eyes. The Therapeutic Relationship in ACT. Creating a Context for Change: Mind versus Experience. Part III: Core Clinical Processes. Sandoz, Present-moment Awareness. Dimensions of Self. Defusion. Acceptance. Values. Committed Action. Part IV: Building a Progressive Scientific Approach. Contextual Behavioral Science and the Future of ACT.

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Acceptance and Commitment Therapy: The Process and Practice of Mindful Change

This article reports on a research synthesis of the relation between alliance and the outcomes of individual psychotherapy. Included were over 200 research reports based on 190 independent data sources, covering more than 14,000 treatments. Research involving 5 or more adult participants receiving genuine (as opposed to analogue) treatments, where the author(s) referred to one of the independent variables as “alliance,” “therapeutic alliance,” “helping alliance,” or “working alliance” were the inclusion criteria. All analyses were done using the assumptions of a random model. The overall aggregate relation between the alliance and treatment outcome (adjusted for sample size and non independence of outcome measures) was r .275 (k 190); the 95% confidence interval for this value was .25–.30. The statistical probability associated with the aggregated relation between alliance and outcome is p .0001. The data collected for this meta-analysis were quite variable (heterogeneous). Potential variables such as assessment perspectives (client, therapist, observer), publication source, types of assessment methods and time of assessment were explored.

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Alliance in individual psychotherapy.

The evidence-based practice movement has become an important feature of health care systems and health care policy. Within this context, the APA 2005 Presidential Task Force on Evidence-Based Practice defines and discusses evidence-based practice in psychology (EBPP). In an integration of science and practice, the Task Force's report describes psychology's fundamental commitment to sophisticated EBPP and takes into account the full range of evidence psychologists and policymakers must consider. Research, clinical expertise, and patient characteristics are all supported as relevant to good outcomes. EBPP promotes effective psychological practice and enhances public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention. The report provides a rationale for and expanded discussion of the EBPP policy statement that was developed by the Task Force and adopted as association policy by the APA Council of Representatives in August 2005.

Evidence-based practice in psychology.

Factors that influence client outcome can be divided into four areas: extratherapeutic factors, expectancy effects, specific therapy techniques, and common factors. Common factors such as empathy, warmth, and the therapeutic relationship have been shown to correlate more highly with client outcome t

Research summary on the therapeutic relationship and psychotherapy outcome.

This recta-analysis tested the Dodo bird conjecture, which states that when psychotherapies intended to be therapeutic are compared, the true differences among all such treatments are 0. Based on comparisons between treatments culled from 6 journals, it was found that the effect sizes were homogeneously distributed about 0, as was expected under the Dodo bird conjecture, and that under the most liberal assumptions, the upper bound of the true effect was about .20. Moreover, the effect sizes (a) were not related positively to publication date, indicating that improving research methods were not detecting effects, and (b) were not related to the similarity of the treatments, indicating that more dissimilar treatments did not produce larger effects, as would be expected if the Dodo bird conjecture was false. The evidence from these analyses supports the conjecture that the efficacy of bona fide treatments are roughly equivalent. In 1936, Rosenzweig proposed that common factors were responsible for the efficacy of psychotherapy and used the conclusion of the Dodo bird from Alice in Wonderland (Carroll, 1865/1962) to emphasize this point: "At last the Dodo said, 'Everybody has won, and all must have prizes' " (p. 412). Later, Luborsky, Singer, and Luborsky ( 1975 ) reviewed the psychotherapy outcome literature, found that the psychotherapies reviewed were generally equivalent in terms of their outcomes, and decreed that the Dodo bird was correct. Since Luborsky et al.'s seminal review, the equivalence of outcome in psychotherapy has been called the Dodo bird effect. To many interested in the technical aspects of particular psychotherapies, the Dodo bird effect was distasteful and, on the face of it, unbelievable: If the indiscriminate distribution of prizes argument carried true conviction . . . we end up with the same advice for everyone"Regardless of the nature of your problem seek any form of psychotherapy." This is absurd. We doubt whether even the strongest advocates of the Dodo bird argument dispense this advice. (Rachman & Wilson, 1980, p. 167)

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A meta-analysis of outcome studies comparing bona fide psychotherapies: Empiricially, "all must have prizes."

The central metaphor used to illustrate the finding that psychotherapies produce generally equivalent outcomes has been that of the Dodo bird, who in Alice in Wonderland (Carroll, 1865/ 1962) exclaimed, "everybody has won, and all must have prizes." In spite of the empirical evidence for the conclusion that there are no differences in relative efficacy among bona fide psychotherapies, the Dodo bird verdict cannot achieve much respect, as witnessed by the commentaries (Crits-Christoph, 1997; Howard, Krause, Saunders, & Kopta, 1997) of the most recent meta-analysis of studies that have compared various psychotherapies (Wampold et al., 1997). It is now time to replace the Dodo bird metaphor with one involving the fiat Earth, a notion that persists in spite of evidence to the contrary.

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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).

Dual discrepancy/consistency pattern of strengths and weaknesses method of specific learning disability identification: Classification accuracy when combining clinical judgment with assessment data.

Marcia Moody

Papers

A meta-analysis of outcome studies comparing bona fide psychotherapies: Empiricially, "all must have prizes."

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).

Dual discrepancy/consistency pattern of strengths and weaknesses method of specific learning disability identification: Classification accuracy when combining clinical judgment with assessment data.