psychotherapy and research

STIJN VANHEULE 93vention modules. Precisely because of this, psychotherapy is easily locatedwithin the framework of evidence-based medicine (EBM), which alsofocuses on clearly delineated treatments and on short-term outcomes (Miles,Loughlin & Polychronis 2007). The EBM paradigm concentrates on directeffects of medical interventions, and was primarily developed for evaluatingmedical intervention modules like pharmacological treatments, which differquite a bit from psychotherapeutic interventions. Nowadays, this paradigm isincreasingly used for studying complex non-pharmacological health interventions.Two questions we can ask are: (1) whether attuning psychotherapyto the evidence-based medicine paradigm is possible given the assumptionsunderlying this paradigm, and (2) whether attuning psychotherapy to thisparadigm violates crucial assumptions underlying psychotherapy. Withrespect to the first question, we can already note that in fact the assumptionsunderlying the EBM paradigm itself are pretty vague. EBM has been criticizedfor its loose theoretical foundation, for its narrowing down of ideas onscience, for its untenable claims of being value free and independent oftheory, as well as for the complete lack of an evidentiary basis demonstratingthe superiority of EBM in clinical practice (Freshwater & Rolfe 2004; Miles,Loughlin & Polychronis 2007; Sturdee 2001).The research procedure guiding EBM is the randomized controlled trial.This is a scientific method principally used in the testing of the efficacy ofmedicines or medical practices. It is a research procedure that aims ateliminating bias from the evaluation of interventions, and that enables scientiststo make conclusions about successful and unsuccessful treatments(Schulz et al. 1995). Based on these trials pharmacological corporations areallowed to launch new products on the pharmaceutical market, and healthinsurance uses this information to refund costs of medical treatments.What is typical of a randomized controlled trial used in medical science?First of all it is a trial, meaning a research design in which a number oftreatments are evaluated and compared to one another. There are two typesof RCTs: efficacy trials and effectiveness trials. ‘Efficacy trials, which usuallyprecede effectiveness studies, refer to those conducted under more ideal,experimental conditions, while effectiveness trials are RCTs carried out inmore routine clinical conditions’ (Tansella et al. 2006, p. 712). Due to thestronger experimental control in the design, evidence from efficacy trials isusually valued more highly than evidence from effectiveness trials (Eccles &Mason 2001).Another core characteristic of RCTs is blinding. Designs are single-blind,double-blind, or triple-blind. Single-blind means that the patient does notknow the details of the treatment: she/he does not know about the differenttreatment conditions, or which treatment condition she/he is in. Doubleblindin its turn means that, in addition to the patient, the doctor orresearcher providing the treatment does not know which treatment conditionhe is providing (for example, a placebo, an old pharmaceutical, or a new