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Paper # 4: Are Rct Designs In Psychotherapy Research Essential And Exclusively Necessary To Advance Es Ts?

2135 words - 9 pages

Many convincing cases have been made both for and against the use of randomized control trails (RCTs) in psychotherapy research. Throughout this paper many of those cases will be explored. In light of the existing literature I believe randomized control trail (RCT) designs are essential in psychotherapy research and in the advancement of empirically supported treatments (EST). I do not, however, believe they are exclusively necessary for their advancement. RCTs are one of the most important components in psychotherapy research but not the only component. Westen et al. (2004a) presents one of most convincing and controversial papers among the literature addressing the use of RCTs in psychotherapy research; the paper by Westen and colleagues addresses some of the major problems with RCT designs and advocates the use of alternative measures for psychotherapy research. I will begin by addressing the issues with RCT designs as discussed in the Westen et al. (2004a) paper, mainly the set of assumptions RCT methodology is believed to rely on, as well as the responses to the allegations. I will turn next to discuss the issues of internal and external validity, as well as some of the advantages and disadvantages of RCT designs, and close with a recommendation for the use of RCTs in the future.
Westen et al. (2004a), brings forth some interesting allegations regarding the use of RCTs. Some of which are widely agreed upon, others which appear to be nothing other than faulty allegations. The argument against the use of RCT designs by Westen et al. (2004a) is founded on the belief that in order for RCT methodologies to validate ESTs a certain set of assumptions must be met, and it is of course argued that these assumptions are not well validated and not widely applicable. I will touch on three of the assumptions brought forth in the Westen et al. (2004a) paper: malleability, comorbidity, and the gold standard of psychotherapeutic packages.
The assumption of malleability was implied via the short treatment length of virtually all ESTs (Westen et al., 2004a). In order for psychotherapy researchers to compare their therapies with medications it was necessary to control for the confound of time (Westen et al., 2004a). The longer the therapy, the more experimental variation, and with more variation comes a weakened ability to draw causal conclusions – resulting in a preference for brief treatments in order to standardize treatment and obtain greater power in obtaining experimental control (Westen et al., 2004a). The short treatment length of RCTs and the strict experimental control is one of the central concerns surrounding the use of RCTs. However, as pointed out by Haaga (2004), Westen’s et al. (2004a) promotion of long-term therapies ignores the issues of cost and patient compliance. The heavy burden of cost and difficulty keeping patients in long term studies are important considerations when comparing longer term and shorter therapies (Haaga, 2004). ...

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